46D1075091 CLIA NUMBER - GRANGER MEDICAL RIVERTON

Laboratory Demographics

  • CLIA Code: 46D1075091
  • Facility Name: GRANGER MEDICAL RIVERTON
  • Facility Address: 12391 S 4000 W, STE 100
    RIVERTON, UT
    ZIP 84096
  • Facility Phone: 801 302-1700
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: STEPHEN B. DEVENPORT, MD
  • NPI Number: 1104567882
  • Taxonomy: 261QM1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 46D1075091
LAB Type Physician Office
Facility Name GRANGER MEDICAL RIVERTON
Street 12391 S 4000 W, STE 100
City RIVERTON
State UT
ZIP 84096
Phone 801 302-1700
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/12/2025
Certificate Expiration Date 10/11/2027
Facility Type Physician Office
Lab Director STEPHEN B. DEVENPORT, MD

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