Healthcare Provider Details

I. General information

NPI: 1891879201
Provider Name (Legal Business Name): DELTA ORTHOPEDICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 05/27/2021
Certification Date: 05/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 COTTONWOOD ST
DELTA CO
81416-4400
US

IV. Provider business mailing address

PO BOX 1129
DELTA CO
81416-1129
US

V. Phone/Fax

Practice location:
  • Phone: 970-399-4200
  • Fax:
Mailing address:
  • Phone: 970-874-2470
  • Fax: 970-874-2475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number42654
License Number StateCO

VIII. Authorized Official

Name: JOHN P KNUTSON
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 970-399-4200