46D1012057 CLIA NUMBER - SHELLY SAVAGE MD LLC GRANDVIEW FAMILY MEDCINE

Laboratory Demographics

  • CLIA Code: 46D1012057
  • Facility Name: SHELLY SAVAGE MD LLC GRANDVIEW FAMILY MEDCINE
  • Facility Address: 1900 NORTH STATE STREET
    PROVO, UT
    ZIP 84604
  • Facility Phone: 801 373-2001
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ANGIE GILLESPIE
  • NPI Number: 1194876078
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 46D1012057
LAB Type Physician Office
Facility Name SHELLY SAVAGE MD LLC GRANDVIEW FAMILY MEDCINE
Street 1900 NORTH STATE STREET
City PROVO
State UT
ZIP 84604
Phone 801 373-2001
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/30/2025
Certificate Expiration Date 4/29/2027
Facility Type Physician Office
Lab Director ANGIE GILLESPIE

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