46D0954750 CLIA NUMBER - TIMPANOGOS DIALYSIS

Laboratory Demographics

  • CLIA Code: 46D0954750
  • Facility Name: TIMPANOGOS DIALYSIS
  • Facility Address: 1055 N 500 W STE 222
    PROVO, UT
    ZIP 84604
  • Facility Phone: 801 356-8907
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: TERRY C. HAMMOND
  • NPI Number: 1831153840
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 46D0954750
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name TIMPANOGOS DIALYSIS
Street 1055 N 500 W STE 222
City PROVO
State UT
ZIP 84604
Phone 801 356-8907
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/8/2024
Certificate Expiration Date 12/7/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director TERRY C. HAMMOND

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