46D1030419 CLIA NUMBER - MOUNTAIN WEST PEDIATRICS

Laboratory Demographics

  • CLIA Code: 46D1030419
  • Facility Name: MOUNTAIN WEST PEDIATRICS
  • Facility Address: 2356 N 400 E, STE 202
    TOOELE, UT
    ZIP 84074
  • Facility Phone: 435 843-8380
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: GORDON DUVAL
  • NPI Number: 1649200296
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 46D1030419
LAB Type Physician Office
Facility Name MOUNTAIN WEST PEDIATRICS
Street 2356 N 400 E, STE 202
City TOOELE
State UT
ZIP 84074
Phone 435 843-8380
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/7/2024
Certificate Expiration Date 9/6/2026
Facility Type Physician Office
Lab Director GORDON DUVAL

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