=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447322755
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LITTLETON ORTHOPAEDIC ASSOCIATES PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2006
-----------------------------------------------------
Last Update Date | 04/17/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7720 S BROADWAY #210
-----------------------------------------------------
City | LITTLETON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80122-2624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-798-8107
-----------------------------------------------------
Fax | 303-798-1756
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7720 S BROADWAY #210
-----------------------------------------------------
City | LITTLETON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80122-2632
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-798-8107
-----------------------------------------------------
Fax | 303-798-1756
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. SUSAN L JOLLY
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 303-798-8107
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------