Provider Demographics
NPI:1366986721
Name:APOLLO HEALTH CENTERS
Entity type:Organization
Organization Name:APOLLO HEALTH CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:CASTILLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:807-685-2862
Mailing Address - Street 1:5525 S 900 E
Mailing Address - Street 2:#310
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-7200
Mailing Address - Country:US
Mailing Address - Phone:801-685-2862
Mailing Address - Fax:
Practice Address - Street 1:5525 S 900 E
Practice Address - Street 2:#310
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84117-7200
Practice Address - Country:US
Practice Address - Phone:801-685-2862
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-05
Last Update Date:2017-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty