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General NPI Number Information
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NPI Number | 1346198173
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Entity Type | Organization
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Legal Business Name | OLYMPUS SURGERY CENTER, LLC
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Dates
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Enumeration Date | 03/18/2026
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Last Update Date | 03/18/2026
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Provider Practice Location Address
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Address Line | 650 E 4500 S STE 110
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City | SALT LAKE CITY
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State | UT
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Zip | 84107-2901
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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 | 3130 S HIGHLAND DR STE B4
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City | MILLCREEK
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State | UT
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Zip | 84106-3095
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Country | US
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Telephone |
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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 S 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 | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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