46D0525415 CLIA NUMBER - UTAH STATE HOSPITAL

Laboratory Demographics

  • CLIA Code: 46D0525415
  • Facility Name: UTAH STATE HOSPITAL
  • Facility Address: 1300 E CENTER
    PROVO, UT
    ZIP 84606
  • Facility Phone: 801 344-4200
  • Facility Type: Other
  • Facility Type: Waiver
  • Lab Director: DALLAS EARNSHAW MS RN
  • NPI Number: 1316218449
  • Taxonomy: 3336I0012X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 46D0525415
LAB Type Other
Facility Name UTAH STATE HOSPITAL
Street 1300 E CENTER
City PROVO
State UT
ZIP 84606
Phone 801 344-4200
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/3/2025
Certificate Expiration Date 1/2/2027
Facility Type Other
Lab Director DALLAS EARNSHAW MS RN

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