Provider Demographics
NPI:1033722087
Name:OLYMPUS HEALING CLINIC
Entity Type:Organization
Organization Name:OLYMPUS HEALING CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:HASKIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-455-1241
Mailing Address - Street 1:2870 E 3300 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-2821
Mailing Address - Country:US
Mailing Address - Phone:801-432-8626
Mailing Address - Fax:
Practice Address - Street 1:2870 E 3300 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84109-2821
Practice Address - Country:US
Practice Address - Phone:801-432-8626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service