SOUTH DENVER PHYSICIANS PLLC - NPI NUMBER 1124463161

Summary

Provider Name: SOUTH DENVER PHYSICIANS PLLC

NPI Number: 1124463161

Clasification: Psychiatry & Neurology (2084N0600X)

Specialization: Clinical Neurophysiology

Address:
27309 E NOVA CIR
AURORA, CO
ZIP 80016

Phone Number: (720) 441-4410



Detailed Information

SOUTH DENVER PHYSICIANS PLLC is a clinical neurophysiologist in Aurora, CO. The provider is clinical Neurophysiology is a subspecialty with psychiatric or neurologic expertise in the diagnosis and management of central, peripheral, and autonomic nervous system disorders using combined clinical evaluation and electrophysiologic testing such as electroencephalography (EEG), electromyography (EMG), and nerve conduction studies (NCS). The assigned NPI number for this provider is 1124463161 and is registered as an organization entity type and is a multiple single specialty group.

The provider's business address is:

27309 E NOVA CIR
AURORA, CO
ZIP 80016-296
Phone: (720) 441-4410

The provider's authorized official is Dmitriy I Pales .
The authorized official title is Sole Member and has the following contact phone number (720) 441-4410.

The enumeration date for this NPI number is 5/3/2013 and was last updated on 5/3/2013.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 2084N0600X Psychiatry & Neurology Clinical Neurophysiology 47080 CO No
2 207R00000X Internal Medicine 46797 CO Yes

NPI Record

No. Field Name Field Value
1 NPI 1124463161
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name SOUTH DENVER PHYSICIANS PLLC
5 Provider First Line Business Practice Location Address 27309 E NOVA CIR
6 Provider Business Practice Location Address City Name AURORA
7 Provider Business Practice Location Address State Name CO
8 Provider Business Practice Location Address Postal Code 800167296
9 Provider Business Practice Location Address Country Code If outside U S US
10 Provider Business Practice Location Address Telephone Number 7204414410
11 Provider Enumeration Date 5/3/2013
12 Last Update Date 5/3/2013
13 Authorized Official Last Name PALES
14 Authorized Official First Name DMITRIY
15 Authorized Official Middle Name I
16 Authorized Official Title or Position SOLE MEMBER
17 Authorized Official Telephone Number 7204414410
18 Healthcare Provider Taxonomy Code 1 2084N0600X
19 Provider License Number 1 47080
20 Provider License Number State Code 1 CO
21 Healthcare Provider Primary Taxonomy Switch 1 N
22 Healthcare Provider Taxonomy Code 2 207R00000X
23 Provider License Number 2 46797
24 Provider License Number State Code 2 CO
25 Healthcare Provider Primary Taxonomy Switch 2 Y
26 Is Organization Subpart N
27 Authorized Official Credential Text DO
28 Healthcare Provider Taxonomy Group 1 193400000X MULTIPLE SINGLE SPECIALTY GROUP
29 Healthcare Provider Taxonomy Group 2 193400000X MULTIPLE SINGLE SPECIALTY GROUP

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This page was last updated on: 3/11/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.