46D0924658 CLIA NUMBER - INTERMOUNTAIN LIBERTY ELEMENTARY FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 46D0924658
  • Facility Name: INTERMOUNTAIN LIBERTY ELEMENTARY FAMILY PRACTICE
  • Facility Address: 1078 SOUTH 300 EAST, MAILBOX #3
    SLC, UT
    ZIP 84111
  • Facility Phone: 801 408-3587
  • Facility Type: Other
  • Facility Type: Microscopy
  • Lab Director: AARON NYDEGGER
  • NPI Number: 1831491430
  • Taxonomy: 282NC0060X - General Acute Care Hospital

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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
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 2/15/2025
Certificate Expiration Date 2/14/2027
Facility Type Other
Lab Director AARON NYDEGGER

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This page was last updated on: 3/20/2025