| Stellar Pcp Llc | |
|
800 E Fort Union Blvd Ste B Midvale UT 84047-2391 | |
| (801) 694-1198 | |
| Not Available |
| Full Name | Stellar Pcp Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 800 E Fort Union Blvd Ste B, Midvale, Utah |
| Authorized Official Name and Position | Joshua Samuel Olschewski (OWNER/CEO) |
| Authorized Official Contact | 8016941198 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Stellar Pcp Llc 800 E Fort Union Blvd Ste B Midvale UT 84047-2391 Ph: (801) 694-1198 | Stellar Pcp Llc 800 E Fort Union Blvd Ste B Midvale UT 84047-2391 Ph: (801) 694-1198 |
| NPI Number | 1144921867 |
|---|---|
| Provider Enumeration Date | 03/10/2023 |
| Last Update Date | 03/10/2023 |
| Medicare PECOS PAC ID | 8729443858 |
|---|---|
| Medicare Enrollment ID | O20230425001804 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144921867 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Gary F Holland |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780780189 PECOS PAC ID: 7618961319 Enrollment ID: I20150407000936 |
| Provider Name | Jennifer N Griswold |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275971483 PECOS PAC ID: 0941560791 Enrollment ID: I20180321002516 |
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