| Ellis R. Shipp Medical Clinic | |
|
4535 S 5600 W West Valley City UT 84120-4639 | |
| (801) 676-4405 | |
| (877) 497-4661 |
| Full Name | Ellis R. Shipp Medical Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 4535 S 5600 W, West Valley City, Utah |
| Authorized Official Name and Position | Jennifer Thomas (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 8014126920 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ellis R. Shipp Medical Clinic 1455 W 2200 S Ste 300 West Valley City UT 84119-7219 Ph: (801) 412-6920 | Ellis R. Shipp Medical Clinic 4535 S 5600 W West Valley City UT 84120-4639 Ph: (801) 676-4405 |
| NPI Number | 1326417445 |
|---|---|
| Provider Enumeration Date | 09/18/2015 |
| Last Update Date | 10/30/2023 |
| Medicare PECOS PAC ID | 5991698169 |
|---|---|
| Medicare Enrollment ID | O20160204001354 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326417445 | NPI | - | NPPES |
| 1326417445 | Medicaid | UT |
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