46D0726399 CLIA NUMBER - NORTHEASTERN UTAH MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 46D0726399
  • Facility Name: NORTHEASTERN UTAH MEDICAL GROUP
  • Facility Address: 210 W 300 N
    ROOSEVELT, UT
    ZIP 84066
  • Facility Phone: 435 722-4691
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: JOHN BLAKE
  • NPI Number: 1679193338
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 46D0726399
LAB Type Physician Office
Facility Name NORTHEASTERN UTAH MEDICAL GROUP
Street 210 W 300 N
City ROOSEVELT
State UT
ZIP 84066
Phone 435 722-4691
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 3/28/2024
Certificate Expiration Date 3/27/2026
Facility Type Physician Office
Lab Director JOHN BLAKE

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