46D0704676 CLIA NUMBER - INTERMOUNTAIN WORKMED - OGDEN/LAYTON

Laboratory Demographics

CLIA Number: 46D0704676

Facility Name: INTERMOUNTAIN WORKMED - OGDEN/LAYTON

Facility Address:
1355 W HINCKLEY DR
OGDEN, UT
ZIP 84401
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Facility Phone Number: 801 387-6150

Facility Type: Community Clinic

Certificate Type: Waiver

NPI Number: 1174852289

Taxonomy: 261QM0850X - Clinic/Center
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults.

CLIA Record

Field Name	Field Value
CLIA Number	46D0704676
LAB Type	Community Clinic
Facility Name	INTERMOUNTAIN WORKMED - OGDEN/LAYTON
Street	1355 W HINCKLEY DR
City	OGDEN
State	UT
ZIP	84401
Phone	801 387-6150
CertificateType	4
CertificateEffectiveDate	8/8/2023
CertificateExpirationDate	8/7/2025
FacilityType	Waiver

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