46D0957143 CLIA NUMBER - MOUNTAINSTAR MEDICAL GROUP-BRIGHAM CITY

Laboratory Demographics

  • CLIA Code: 46D0957143
  • Facility Name: MOUNTAINSTAR MEDICAL GROUP-BRIGHAM CITY
  • Facility Address: 970 S MEDICAL DRIVE, SUITE 202
    BRIGHAM CITY, UT
    ZIP 84302
  • Facility Phone: 435 695-2273
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: STANTON A. BAILEY
  • NPI Number: 1134379696
  • Taxonomy: 207V00000X - Obstetrics & Gynecology

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CLIA Record

Field Name Field Value
CLIA Number 46D0957143
LAB Type Physician Office
Facility Name MOUNTAINSTAR MEDICAL GROUP-BRIGHAM CITY
Street 970 S MEDICAL DRIVE, SUITE 202
City BRIGHAM CITY
State UT
ZIP 84302
Phone 435 695-2273
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/8/2024
Certificate Expiration Date 6/7/2026
Facility Type Physician Office
Lab Director STANTON A. BAILEY

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