Provider Demographics
NPI:1538354568
Name:THE LITTLE CLINIC OF COLORADO, LLC
Entity type:Organization
Organization Name:THE LITTLE CLINIC OF COLORADO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:R
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-425-4200
Mailing Address - Street 1:PO BOX 932958
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0028
Mailing Address - Country:US
Mailing Address - Phone:615-425-4200
Mailing Address - Fax:615-891-5244
Practice Address - Street 1:9551 S UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80126
Practice Address - Country:US
Practice Address - Phone:303-459-5639
Practice Address - Fax:303-459-5640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000165041Medicaid
CO9000165045Medicaid
CO9000165039Medicaid
CO9000165040Medicaid
CO9000165174Medicaid
CO9000165407Medicaid
CO9000165586Medicaid
CO9000165173Medicaid
CO9000165438Medicaid
CO9000165064Medicaid
CO9000165171Medicaid
CO9000165042Medicaid
CO9000165226Medicaid
CO9000165350Medicaid
CO9000165847Medicaid
CO9000165196Medicaid
CO9000165227Medicaid
CO9000165406Medicaid
CO9000165038Medicaid
CO9000165165Medicaid