Healthcare Provider Details

I. General information

NPI: 1881216646
Provider Name (Legal Business Name): SUMMIT MEDICAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2020
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 N 500 W STE 103
PROVO UT
84601-1552
US

IV. Provider business mailing address

9980 S 300 W STE 310
SANDY UT
84070-3654
US

V. Phone/Fax

Practice location:
  • Phone: 801-253-6886
  • Fax: 801-253-6888
Mailing address:
  • Phone: 801-253-6886
  • Fax: 385-900-5928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RYAN ELLSWORTH
Title or Position: OWNER
Credential: DPM
Phone: 801-550-0955