Provider Demographics
NPI:1295342202
Name:VORTEX LLC
Entity type:Organization
Organization Name:VORTEX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:N
Authorized Official - Last Name:DOWNING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-262-4662
Mailing Address - Street 1:6095 S FASHION BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-7395
Mailing Address - Country:US
Mailing Address - Phone:801-262-4662
Mailing Address - Fax:
Practice Address - Street 1:6095 S FASHION BLVD STE 200
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-7395
Practice Address - Country:US
Practice Address - Phone:801-262-4662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental