Provider Demographics
NPI:1477951911
Name:SOUTH DENVER OB/GYN, PC
Entity Type:Organization
Organization Name:SOUTH DENVER OB/GYN, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:LENNON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:720-273-3983
Mailing Address - Street 1:7780 S BROADWAY
Mailing Address - Street 2:SUITE 280
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80122-2648
Mailing Address - Country:US
Mailing Address - Phone:303-738-1100
Mailing Address - Fax:303-738-1310
Practice Address - Street 1:7780 S BROADWAY STE 280
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-2633
Practice Address - Country:US
Practice Address - Phone:303-738-1100
Practice Address - Fax:303-738-1310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-16
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO57256047Medicaid