Healthcare Provider Details

I. General information

NPI: 1457986051
Provider Name (Legal Business Name): SIBYL DOWNING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2020
Last Update Date: 10/06/2023
Certification Date: 03/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1918 N WOODBINE RD
SAINT JOSEPH MO
64506
US

IV. Provider business mailing address

1918 N WOODBINE RD
SAINT JOSEPH MO
64506
US

V. Phone/Fax

Practice location:
  • Phone: 816-396-8855
  • Fax: 816-396-6123
Mailing address:
  • Phone: 816-396-8855
  • Fax: 816-396-6123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SIBYL DOWNING
Title or Position: OWNER
Credential: MD
Phone: 816-273-6320