46D0924658 CLIA NUMBER - INTERMOUNTAIN LIBERTY ELEMENTARY FAMILY PRACTICE

Laboratory Demographics

CLIA Number: 46D0924658

Facility Name: INTERMOUNTAIN LIBERTY ELEMENTARY FAMILY PRACTICE

Facility Address:
1078 SOUTH 300 EAST, MAILBOX #3
SLC, UT
ZIP 84111
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Facility Phone Number: 801 408-3587

Facility Type: Other

Certificate Type: Microscopy

NPI Number: 1831491430

Taxonomy: 282NC0060X - General Acute Care Hospital

CLIA Record

Field Name	Field Value
CLIA Number	46D0924658
LAB Type	Other
Facility Name	INTERMOUNTAIN LIBERTY ELEMENTARY FAMILY PRACTICE
Street	1078 SOUTH 300 EAST, MAILBOX #3
City	SLC
State	UT
ZIP	84111
Phone	801 408-3587
CertificateType	3
CertificateEffectiveDate	2/15/2023
CertificateExpirationDate	2/14/2025
FacilityType	PPMP

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