06D2140878 CLIA NUMBER - INTERMOUNTAIN HEALTH CANCER CENTER -LUTHERAN

Laboratory Demographics

  • CLIA Code: 06D2140878
  • Facility Name: INTERMOUNTAIN HEALTH CANCER CENTER -LUTHERAN
  • Facility Address: 400 INDIANA ST, SUITE 300
    GOLDEN, CO
    ZIP 80401
  • Facility Phone: 303 403-7333
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. KARNG S. LOG
  • NPI Number: 1700490299
  • Taxonomy: 207RX0202X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 06D2140878
LAB Type Physician Office
Facility Name INTERMOUNTAIN HEALTH CANCER CENTER -LUTHERAN
Street 400 INDIANA ST, SUITE 300
City GOLDEN
State CO
ZIP 80401
Phone 303 403-7333
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/4/2023
Certificate Expiration Date 12/3/2025
Facility Type Physician Office
Lab Director DR. KARNG S. LOG

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This page was last updated on: 9/29/2025