| Olympus Clinic | |
|
4624 Holladay Blvd Salt Lake City UT 84117-5206 | |
| (801) 277-2682 | |
| (801) 277-2980 |
| Full Name | Olympus Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 4624 Holladay Blvd, Salt Lake City, Utah |
| Authorized Official Name and Position | Troy A Fuller (OFFICE MANAGER) |
| Authorized Official Contact | 8012772682 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Olympus Clinic 4624 Holladay Blvd Salt Lake City UT 84117-5206 Ph: (801) 277-2682 | Olympus Clinic 4624 Holladay Blvd Salt Lake City UT 84117-5206 Ph: (801) 277-2682 |
| NPI Number | 1508810508 |
|---|---|
| Provider Enumeration Date | 05/22/2006 |
| Last Update Date | 03/04/2008 |
| Medicare PECOS PAC ID | 8921991506 |
|---|---|
| Medicare Enrollment ID | O20040206000213 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508810508 | NPI | - | NPPES |
| CP7822 | Other | UT | MEDICARE RAILROAD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 5533 (Utah) | Primary |
| Provider Name | Dana Marie Shaw |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871532101 PECOS PAC ID: 4880596196 Enrollment ID: I20040126000433 |
| Provider Name | Ann Jefferds |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1386691558 PECOS PAC ID: 4082608641 Enrollment ID: I20040414001359 |
| Provider Name | Steven Heath |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1366497166 PECOS PAC ID: 8426131293 Enrollment ID: I20110114001015 |
| Provider Name | Jon T Wall |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1528006491 PECOS PAC ID: 9335222108 Enrollment ID: I20110114001027 |
| Provider Name | Jared Bailey Probst |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346295177 PECOS PAC ID: 1456244037 Enrollment ID: I20110120000265 |
| Provider Name | Robert C Hill |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1770521643 PECOS PAC ID: 5698858462 Enrollment ID: I20110120000607 |
| Provider Name | Christopher James Gamble |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487609277 PECOS PAC ID: 1153404926 Enrollment ID: I20110126000544 |
| Provider Name | Kristen M Romo |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407177173 PECOS PAC ID: 5496990780 Enrollment ID: I20130711000754 |
| Provider Name | Catherine D Coates |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811441082 PECOS PAC ID: 6901187228 Enrollment ID: I20161228002207 |
| Provider Name | Shannon W Quinn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215583059 PECOS PAC ID: 6103251251 Enrollment ID: I20210325000547 |
| Provider Name | Marysia A Watson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811488695 PECOS PAC ID: 4284032145 Enrollment ID: I20211006002389 |
| Provider Name | Megan Schwartz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1538665229 PECOS PAC ID: 6800143298 Enrollment ID: I20220602001218 |
| Provider Name | Benjamin Paul Neff |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386106060 PECOS PAC ID: 5395164164 Enrollment ID: I20220727003425 |
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