Healthcare Provider Details

I. General information

NPI: 1497084776
Provider Name (Legal Business Name): LITTLETON SURGICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2009
Last Update Date: 07/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7780 S BROADWAY SUITE 350
LITTLETON CO
80122-2648
US

IV. Provider business mailing address

5265 SKYTRAIL DR
LITTLETON CO
80123-1566
US

V. Phone/Fax

Practice location:
  • Phone: 303-734-8650
  • Fax: 303-734-8653
Mailing address:
  • Phone: 303-734-8650
  • Fax: 303-734-8653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number36243
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number36243
License Number StateCO

VIII. Authorized Official

Name: DR. JOHN ADAIR PRALL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 303-734-8650