46D1075091 CLIA NUMBER - GRANGER MEDICAL RIVERTON

Laboratory Demographics

CLIA Number: 46D1075091

Facility Name: GRANGER MEDICAL RIVERTON

Facility Address:
12391 S 4000 W, STE 100
RIVERTON, UT
ZIP 84096
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Facility Phone Number: 801 302-1700

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1104567882

Taxonomy: 261QM1300X - Clinic/Center

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
CertificateType	4
CertificateEffectiveDate	10/12/2023
CertificateExpirationDate	10/11/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024