Provider Demographics
NPI:1356974356
Name:LITTLETON PEDIATRIC MEDICAL CENTER
Entity type:Organization
Organization Name:LITTLETON PEDIATRIC MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:L
Authorized Official - Last Name:WOOLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-791-9999
Mailing Address - Street 1:206 W COUNTY LINE RD STE 110
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-2319
Mailing Address - Country:US
Mailing Address - Phone:303-791-9999
Mailing Address - Fax:303-791-2778
Practice Address - Street 1:8340 SANGRE DE CRISTO RD
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-4248
Practice Address - Country:US
Practice Address - Phone:303-979-1234
Practice Address - Fax:303-791-2778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-18
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1356974356Medicaid