# NOEL NELLIS, MD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1447644240
- **Authorized official:** DR. NOEL NELLIS MD (PHYSICIAN & SURGEON)
- **Authorized official phone:** (801) 479-9715

## Contact information

- **Practice address:** 831 E 5875 S, SOUTH OGDEN, UT 84405-4997
- **Practice address phone:** (801) 479-9715
- **Practice address fax:** (801) 479-9452
- **Mailing address:** 831 E 5875 S, SOUTH OGDEN, UT 84405-4997
- **Mailing address phone:** (801) 479-9715
- **Mailing address fax:** (801) 479-9452

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 146023-1205 | UT | — |
| 261QU0200X | Urgent Care Clinic/Center | 146023-1205 | UT | Yes |
| 305S00000X | Point of Service | 146023-1205 | UT | — |

## Other

- **Enumeration date:** 03/19/2015
- **Last updated:** 03/19/2015