MEDICARE: AMPELIS HEALTH HIGHLAND

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1003588369
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMPELIS HEALTH HIGHLAND

Provider Business Mailing Address
First Line	:	10290 N NORTH COUNTY BLVD STE 102
Second Line	:
City	:	HIGHLAND
State	:	UT
Zip	:	84003-8973
Country	:	US
Telephone Number	:	435-776-5909
Fax Number	:

Provider Business Practice Location Address
First Line	:	10290 N NORTH COUNTY BLVD STE 102
Second Line	:
City	:	HIGHLAND
State	:	UT
Zip	:	84003-8973
Country	:	US
Telephone Number	:	435-776-5909
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	JUSTIN WEEKS
Credential	:
Telephone Number	:	801-391-6660

Provider Enumeration Date	:	10/04/2021
Last Update Date	:	12/19/2024

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Directions to “AMPELIS HEALTH HIGHLAND ” Practice Location

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