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General NPI Number Information
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NPI Number | 1134865595
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Entity Type | Organization
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Legal Business Name | AMBLE MEDICAL
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Dates
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Enumeration Date | 05/09/2022
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Last Update Date | 09/27/2024
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Provider Practice Location Address
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Address Line | 9980 S 300 W STE 300
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City | SANDY
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State | UT
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Zip | 84070-3654
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Country | US
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Telephone | 801-253-6886
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Fax |
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Provider Business Mailing Address
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Address Line | 9980 S 300 W STE 300
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City | SANDY
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State | UT
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Zip | 84070-3654
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Country | US
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Telephone | 801-253-6886
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | RYAN SCOTT ELLSWORTH
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Credential | DPM
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Telephone | 801-253-6886
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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