Healthcare Provider Details

I. General information

NPI: 1346198173
Provider Name (Legal Business Name): OLYMPUS SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2026
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 E 4500 S STE 110
SALT LAKE CITY UT
84107-2901
US

IV. Provider business mailing address

3130 S HIGHLAND DR STE B4
MILLCREEK UT
84106-3095
US

V. Phone/Fax

Practice location:
  • Phone: 801-253-6886
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

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