46D0959710 CLIA NUMBER - INTERMOUNTAIN LIFE FLIGHT PRIMARY CHILDREN'S HOSPITAL

Laboratory Demographics

  • CLIA Code: 46D0959710
  • Facility Name: INTERMOUNTAIN LIFE FLIGHT PRIMARY CHILDREN'S HOSPITAL
  • Facility Address: 100 NORTH MARIO CAPECCHI DRIVE
    SALT LAKE CITY, UT
    ZIP 84113
  • Facility Phone: 801 662-2136
  • Facility Type: Mobile Laboratory
  • Facility Type: Certificate of Compliance
  • Lab Director: JAYSON V. PAGADUAN PHD
  • NPI Number: 1790230860
  • Taxonomy: 282NC2000X - General Acute Care Hospital

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CLIA Record

Field Name Field Value
CLIA Number 46D0959710
LAB Type Mobile Laboratory
Facility Name INTERMOUNTAIN LIFE FLIGHT PRIMARY CHILDREN'S HOSPITAL
Street 100 NORTH MARIO CAPECCHI DRIVE
City SALT LAKE CITY
State UT
ZIP 84113
Phone 801 662-2136
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 10/18/2023
Certificate Expiration Date 10/31/2025
Facility Type Mobile Laboratory
Lab Director JAYSON V. PAGADUAN PHD

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