Provider Demographics
NPI:1215380886
Name:DELTA ORTHOPEDICS, LLC
Entity Type:Organization
Organization Name:DELTA ORTHOPEDICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:KNUTSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-399-4200
Mailing Address - Street 1:22411 T RD
Mailing Address - Street 2:
Mailing Address - City:CEDAREDGE
Mailing Address - State:CO
Mailing Address - Zip Code:81413-8318
Mailing Address - Country:US
Mailing Address - Phone:970-399-4200
Mailing Address - Fax:970-399-4219
Practice Address - Street 1:257 COTTONWOOD ST
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416-4400
Practice Address - Country:US
Practice Address - Phone:970-399-4200
Practice Address - Fax:970-399-4219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-19
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42654207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO11733039Medicaid
CO28626532Medicaid
COKN800809OtherBCBS
COKN800809OtherBCBS
COC806696Medicare PIN
COP00412944Medicare PIN
CO5840060001Medicare NSC
CO11733039Medicaid
COC532738Medicare PIN