46D1099453 CLIA NUMBER - INTERMOUNTAIN SYRACUSE CLINIC

Laboratory Demographics

  • CLIA Code: 46D1099453
  • Facility Name: INTERMOUNTAIN SYRACUSE CLINIC
  • Facility Address: 745 SOUTH 2000 WEST
    SYRACUSE, UT
    ZIP 84075
  • Facility Phone: 801 525-2400
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: BENJAMIN G. LAROSE
  • NPI Number: 1780048868
  • Taxonomy: 1223E0200X - Dentist

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CLIA Record

Field Name Field Value
CLIA Number 46D1099453
LAB Type Physician Office
Facility Name INTERMOUNTAIN SYRACUSE CLINIC
Street 745 SOUTH 2000 WEST
City SYRACUSE
State UT
ZIP 84075
Phone 801 525-2400
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/22/2024
Certificate Expiration Date 2/21/2026
Facility Type Physician Office
Lab Director BENJAMIN G. LAROSE

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