46D0524223 CLIA NUMBER - INTERMOUNTAIN HOLLADAY PEDIATRICS NORTH

Laboratory Demographics

  • CLIA Code: 46D0524223
  • Facility Name: INTERMOUNTAIN HOLLADAY PEDIATRICS NORTH
  • Facility Address: 2160 E 4500 S
    SALT LAKE CITY, UT
    ZIP 84117
  • Facility Phone: 801 278-4693
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: JED VANDENBERGHE
  • NPI Number: 1588847008
  • Taxonomy: 103T00000X - Psychologist

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CLIA Record

Field Name Field Value
CLIA Number 46D0524223
LAB Type Physician Office
Facility Name INTERMOUNTAIN HOLLADAY PEDIATRICS NORTH
Street 2160 E 4500 S
City SALT LAKE CITY
State UT
ZIP 84117
Phone 801 278-4693
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 6/6/2025
Certificate Expiration Date 6/5/2027
Facility Type Physician Office
Lab Director JED VANDENBERGHE

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