Healthcare Provider Details

I. General information

NPI: 1053764431
Provider Name (Legal Business Name): OLYMPUS FAMILY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2016
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4624 S HOLLADAY BLVD STE 100
SALT LAKE CITY UT
84117-7056
US

IV. Provider business mailing address

4624 S HOLLADAY BLVD STE 100
SALT LAKE CITY UT
84117-7056
US

V. Phone/Fax

Practice location:
  • Phone: 801-277-2682
  • Fax: 801-277-2980
Mailing address:
  • Phone: 801-277-2682
  • Fax: 801-277-2980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number98642974405
License Number StateUT

VIII. Authorized Official

Name: CHRISTINE KRISPINSKY
Title or Position: OFFICE MANAGER
Credential:
Phone: 801-702-3810