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46D1092063 CLIA NUMBER - MOUNTAIN STAR CARDIOVASCULAR SURGERY-OGDEN

Laboratory Demographics

CLIA Number: 46D1092063

Facility Name: MOUNTAIN STAR CARDIOVASCULAR SURGERY-OGDEN

Facility Address:
425 E 5350 S, SUITE 405
OGDEN, UT
ZIP 84405
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Facility Phone Number: 801 476-6900

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1639350705

Taxonomy: 208G00000X - Thoracic Surgery (Cardiothoracic Vascular Surgery)
A thoracic surgeon provides the operative, perioperative and critical care of patients with pathologic conditions within the chest. Included is the surgical care of coronary artery disease, cancers of the lung, esophagus and chest wall, abnormalities of the trachea, abnormalities of the great vessels and heart valves, congenital anomalies, tumors of the mediastinum and diseases of the diaphragm. The management of the airway and injuries of the chest is within the scope of the specialty.

CLIA Record

Field Name Field Value
CLIA Number 46D1092063
LAB Type Physician Office
Facility Name MOUNTAIN STAR CARDIOVASCULAR SURGERY-OGDEN
Street 425 E 5350 S, SUITE 405
City OGDEN
State UT
ZIP 84405
Phone 801 476-6900
CertificateType 4
CertificateEffectiveDate 11/17/2022
CertificateExpirationDate 11/16/2024
FacilityType Waiver

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