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NPI Code Detail

MEDICARE: THE LITTLE CLINIC OF COLORADO LLC

MEDICARE: THE LITTLE CLINIC OF COLORADO LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant
2363LF0000XFamily Nurse Practitioner

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1538766340
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE LITTLE CLINIC OF COLORADO LLC
Provider Business Mailing Address
First Line : PO BOX 932958
Second Line :
City : CLEVELAND
State : OH
Zip : 44193-0028
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5544 PROMENADE PKWY
Second Line :
City : CASTLE ROCK
State : CO
Zip : 80108-1903
Country : US
Telephone Number : 303-562-9157
Fax Number : 303-562-9161
Authorized Official
Title or Position : VP & GENERAL MANAGER
Name : MR. THOMAS SHELLY
Credential :
Telephone Number : 615-425-4200
Provider Enumeration Date : 10/05/2020
Last Update Date : 10/22/2025

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Directions to “THE LITTLE CLINIC OF COLORADO LLC ” Practice Location

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