Healthcare Provider Details

I. General information

NPI: 1982496253
Provider Name (Legal Business Name): AMBLE MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2025
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 FALCON RIDGE PKWY STE 401
MESQUITE NV
89027-8851
US

IV. Provider business mailing address

DEPT. 624 P.O BOX 30015
SALT LAKE CITY UT
84130-0015
US

V. Phone/Fax

Practice location:
  • Phone: 801-273-0001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: RYAN SCOTT ELLSWORTH
Title or Position: CEO
Credential: DPM
Phone: 801-253-6886