Provider Demographics
NPI:1891879201
Name:DELTA ORTHOPEDICS, LLC
Entity Type:Organization
Organization Name:DELTA ORTHOPEDICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
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:PO BOX 1129
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:CO
Mailing Address - Zip Code:81416-1129
Mailing Address - Country:US
Mailing Address - Phone:970-874-2470
Mailing Address - Fax:970-874-2475
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2021-05-27
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
CO28626532Medicaid
CO611779000OtherOWCP
CODEK00809OtherBCBS
CODEK00809OtherBCBS
CO611779000OtherOWCP
H48867Medicare UPIN
COC806695Medicare PIN