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General NPI Number Information
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NPI Number | 1013514819
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Entity Type | Organization
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Legal Business Name | THE LITTLE CLINIC OF COLORADO LLC
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Dates
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Enumeration Date | 10/05/2020
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Last Update Date | 10/22/2025
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Provider Practice Location Address
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Address Line | 7984 W ALAMEDA AVE
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City | LAKEWOOD
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State | CO
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Zip | 80226-3025
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Country | US
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Telephone | 303-459-7105
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Fax | 303-459-7106
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Provider Business Mailing Address
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Address Line | PO BOX 932958
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City | CLEVELAND
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State | OH
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Zip | 44193-0028
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Country | US
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Telephone | 888-852-2567
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Fax |
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Authorized Official
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Title or Position | VP & GENERAL MANAGER
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Name | MR. THOMAS SHELLY
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Credential |
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Telephone | 615-425-4200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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