Provider Demographics
NPI:1073953162
Name:SOUTH DOWNING PROFESSIONAL, LLC
Entity Type:Organization
Organization Name:SOUTH DOWNING PROFESSIONAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PANTHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-308-4567
Mailing Address - Street 1:PO BOX 237
Mailing Address - Street 2:
Mailing Address - City:OSAKIS
Mailing Address - State:MN
Mailing Address - Zip Code:56360-0237
Mailing Address - Country:US
Mailing Address - Phone:720-308-4567
Mailing Address - Fax:303-459-5180
Practice Address - Street 1:5756 GENOA WAY
Practice Address - Street 2:# 205
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80019-2090
Practice Address - Country:US
Practice Address - Phone:720-308-4567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-03
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Multi-Specialty