Provider Demographics
NPI:1619190899
Name:MT. OLYMPUS OBSTETRICS AND GYNECOLOGY
Entity Type:Organization
Organization Name:MT. OLYMPUS OBSTETRICS AND GYNECOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BECKIE
Authorized Official - Middle Name:H
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-685-7188
Mailing Address - Street 1:1220 E 3900 S
Mailing Address - Street 2:SUITE 3E
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1327
Mailing Address - Country:US
Mailing Address - Phone:801-685-7188
Mailing Address - Fax:801-685-8116
Practice Address - Street 1:1220 E 3900 S
Practice Address - Street 2:SUITE 3E
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1327
Practice Address - Country:US
Practice Address - Phone:801-685-7188
Practice Address - Fax:801-685-8116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty