46D0524274 CLIA NUMBER - OLYMPUS FAMILY MEDICINE

Laboratory Demographics

CLIA Number: 46D0524274

Facility Name: OLYMPUS FAMILY MEDICINE

Facility Address:
4624 S HOLLADAY BLVD SUITE 100 ATTENTION CHRISTINE KRISPINSKY
HOLLADAY, UT
ZIP 84117
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Facility Phone Number: 801 277-2682

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1053764431

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	46D0524274
LAB Type	Physician Office
Facility Name	OLYMPUS FAMILY MEDICINE
Street	4624 S HOLLADAY BLVD SUITE 100 ATTENTION CHRISTINE KRISPINSKY
City	HOLLADAY
State	UT
ZIP	84117
Phone	801 277-2682
CertificateType	3
CertificateEffectiveDate	6/1/2023
CertificateExpirationDate	5/31/2025
FacilityType	PPMP

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This page was last updated on: 4/23/2024