Jon T Wall (NPI# 1528006491, PAC ID# 9335222108) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is FAMILY PRACTICE.
| Nation Provider ID (NPI) | 1528006491 |
| PAC ID by PECOS | 9335222108 |
| Professional Enrollment ID | I20110114001027 |
| Full Name | Jon T Wall |
| Organization Legal Name | OLYMPUS CLINIC |
| Address |
4624 S Holladay Blvd Suite 100 Salt Lake City UT 84117-7056 |
| Phone Number | 8012772682 |
| Gender | M |
| Graduation Year | 1975 |
| Primary Specialty | FAMILY PRACTICE |
| Group Practice PAC ID | 8921991506 |
| Number of Group Practice Members | 8 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 460010 | INTERMOUNTAIN MEDICAL CENTER |
| 460047 | ST MARKS HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 4624 S Holladay Blvd, Suite 100, Salt Lake City, UT 84117-7056 | 8012772682 | OLYMPUS CLINIC |
| 4624 S Holladay Blvd, Salt Lake City, UT 84117-7056 | 8012772682 | OLYMPUS CLINIC |
| Organization Legal Name | OLYMPUS CLINIC |
| Physicians | 12 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Jared Bailey Probst | Family Medicine | Olympus Clinic | 4624 S Holladay Blvd, Suite 100, Salt Lake City, UT 84117-7056 |
| Steven Heath | Family Medicine | Olympus Clinic | 4624 S Holladay Blvd, Suite 100, Salt Lake City, UT 84117-7056 |
| Ann Jefferds | Internal Medicine | Olympus Clinic | 4624 S Holladay Blvd, Suite 100, Salt Lake City, UT 84117-7056 |
| Kristen M Romo | Family Medicine | Olympus Clinic | 4624 S Holladay Blvd, Suite 100, Salt Lake City, UT 84117-7056 |
| Christopher James Gamble | Family Medicine | Olympus Clinic | 4624 S Holladay Blvd, Suite 100, Salt Lake City, UT 84117-7056 |
| Robert C Hill Jr. | Family Medicine | Olympus Clinic | 4624 S Holladay Blvd, Suite 100, Salt Lake City, UT 84117-7056 |
| Catherine D Coates | Nurse Practitioner | Olympus Clinic | 4624 S Holladay Blvd, Suite 100, Salt Lake City, UT 84117-7056 |
| Dana Marie Shaw | Nurse Practitioner | Olympus Clinic | 4624 S Holladay Blvd, Suite 100, Salt Lake City, UT 84117-7056 |
| Sally A Epperson | Nurse Practitioner | Olympus Clinic | 4624 S Holladay Blvd, Suite 100, Salt Lake City, UT 84117-7056 |
| Grant Wells Jackson | Family Practice | Olympus Clinic | 4624 S Holladay Blvd, Suite 100, Salt Lake City, UT 84117-7056 |
| Street Address |
4624 S HOLLADAY BLVD SUITE 100 |
| City | SALT LAKE CITY |
| State | UT |
| Zip | 84117-7056 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Aaron E Frodsham | Interventional Radiology | Physician Medical Group | 4624 S Holladay Blvd, Suite 202, Salt Lake City, UT 84117-7168 |
| Jared Bailey Probst | Family Medicine | Olympus Clinic | 4624 S Holladay Blvd, Suite 100, Salt Lake City, UT 84117-7056 |
| Taylor G Wright | Podiatry | Taylor G Wright PC | 4624 S Holladay Blvd, Suite 201, Salt Lake City, UT 84117-7168 |
| Gina Hill | Nurse Practitioner | Physician Medical Group | 4624 S Holladay Blvd, Suite 202, Salt Lake City, UT 84117-7168 |
| Steven Heath | Family Medicine | Olympus Clinic | 4624 S Holladay Blvd, Suite 100, Salt Lake City, UT 84117-7056 |
| Ann Jefferds | Internal Medicine | Olympus Clinic | 4624 S Holladay Blvd, Suite 100, Salt Lake City, UT 84117-7056 |
| Kristen M Romo | Family Medicine | Olympus Clinic | 4624 S Holladay Blvd, Suite 100, Salt Lake City, UT 84117-7056 |
| Christopher James Gamble | Family Medicine | Olympus Clinic | 4624 S Holladay Blvd, Suite 100, Salt Lake City, UT 84117-7056 |
| John A Whitehead | Physician Assistant | Physician Medical Group | 4624 S Holladay Blvd, Suite 202, Salt Lake City, UT 84117-7168 |
| Douglas A Toole | Podiatry | Taylor G Wright PC | 4624 S Holladay Blvd, Suite 201, Salt Lake City, UT 84117-7168 |
| Find all physicians in the same address | |||
| Name | Specialty | Organization | Address |
|---|---|---|---|
| David A Mehregan | Pathology | Utah Pathology Service Inc | 5330 S 900 E, Suite 120, Salt Lake City, UT 84117-3504 |
| Julie A Jackson | Pathology | Utah Pathology Service Inc | 5330 S 900 E, Suite 120, Salt Lake City, UT 84117-3504 |
| Isaac E Lloyd | Pathology | Utah Pathology Service Inc | 5330 S 900 E, Suite 120, Salt Lake City, UT 84117-3504 |
| Ralph W Gant | Clinical Psychologist | 5525 S 900 E Plaza II, Suite 102, Murray, UT 84117-3505 | |
| Scott Asay | Chiropractic | Apollo Health Centers | 5525 S 900, Suite 310, Murray, UT 84117-3516 |
| Timothy P Young | Family Medicine | Apollo Health Centers | 5525 S 900, Suite 310, Murray, UT 84117-3516 |
| Travis Castillon | Chiropractic | Apollo Health Centers | 5525 S 900, Suite 310, Murray, UT 84117-3516 |
| Jason Dayne Petersen | Plastic and Reconstructive Surgery | J Dayne Petersen Md PC | 5353 S 960, Salt Lake City, UT 84117-3533 |
| Summer Rae Kottsick | Nurse Practitioner | Ihc Health Services Inc | 2160 E 4500, Holladay Pedia N, Salt Lake City, UT 84117-4011 |
| Andrea Loving | Nurse Practitioner | 2180 E 4500, Suite 105, Holladay, UT 84117-4017 | |
| Find all physicians in zip 84117 | |||
| City | SALT LAKE CITY |
| Zip Code | 84117 |
| Specialty | FAMILY PRACTICE |
| City + Specialty | SALT LAKE CITY + FAMILY PRACTICE |
Please comment or provide details below to improve the information on Jon T Wall.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.