Provider Demographics
NPI:1023001526
Name:LITTLETON INTERNAL MEDICINE ASSOCIATES
Entity type:Organization
Organization Name:LITTLETON INTERNAL MEDICINE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CONWAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-798-9996
Mailing Address - Street 1:7780 S BROADWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80122-2648
Mailing Address - Country:US
Mailing Address - Phone:303-798-9996
Mailing Address - Fax:303-730-1145
Practice Address - Street 1:7780 S BROADWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-2648
Practice Address - Country:US
Practice Address - Phone:303-798-9996
Practice Address - Fax:303-730-1145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04016861Medicaid
CO04016861Medicaid