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General NPI Number Information
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NPI Number | 1447644240
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Entity Type | Organization
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Legal Business Name | NOEL NELLIS, MD
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Dates
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Enumeration Date | 03/19/2015
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Last Update Date | 03/19/2015
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Provider Practice Location Address
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Address Line | 831 E 5875 S
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City | SOUTH OGDEN
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State | UT
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Zip | 84405-4997
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Country | US
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Telephone | 801-479-9715
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Fax | 801-479-9452
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Provider Business Mailing Address
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Address Line | 831 E 5875 S
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City | SOUTH OGDEN
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State | UT
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Zip | 84405-4997
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Country | US
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Telephone | 801-479-9715
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Fax | 801-479-9452
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Authorized Official
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Title or Position | PHYSICIAN & SURGEON
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Name | DR. NOEL NELLIS
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Credential | MD
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Telephone | 801-479-9715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 146023-1205
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 146023-1205
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License Number State | UT
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Taxonomy #3
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 146023-1205
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License Number State | UT
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