Organization
OLYMPUS CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TROY A FULLER (OFFICE MANAGER)
(801) 277-2682
Entity
Organization
Contact information
Practice address
4624 HOLLADAY BLVD, SALT LAKE CITY, UT 84117-5206
(801) 277-2682
(801) 277-2980
Mailing address
4624 HOLLADAY BLVD, SALT LAKE CITY, UT 84117-5206
(801) 277-2682
(801) 277-2980
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5533
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CP7822
MEDICARE RAILROAD
UT
Enumeration date
05/22/2006
Last updated
03/04/2008
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