Provider Demographics
NPI:1942936091
Name:AMPELIS HEALTH AT MINDFUL MEDICAL
Entity Type:Organization
Organization Name:AMPELIS HEALTH AT MINDFUL MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:REED
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-776-5909
Mailing Address - Street 1:10290 N NORTH COUNTY BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:UT
Mailing Address - Zip Code:84003-8973
Mailing Address - Country:US
Mailing Address - Phone:435-776-5909
Mailing Address - Fax:
Practice Address - Street 1:1525 E 6000 S
Practice Address - Street 2:
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-7144
Practice Address - Country:US
Practice Address - Phone:801-337-5854
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-29
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty