46D1102255 CLIA NUMBER - INTERMOUNTAIN MORONI CLINIC

Laboratory Demographics

  • CLIA Code: 46D1102255
  • Facility Name: INTERMOUNTAIN MORONI CLINIC
  • Facility Address: 51 EAST MAIN
    MORONI, UT
    ZIP 84646
  • Facility Phone: 435 436-5250
  • Facility Type: Rural Health Clinic
  • Facility Type: Microscopy
  • Lab Director: EILEEN K. JACKSON
  • NPI Number: 1386299287
  • Taxonomy: 261QM0801X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 46D1102255
LAB Type Rural Health Clinic
Facility Name INTERMOUNTAIN MORONI CLINIC
Street 51 EAST MAIN
City MORONI
State UT
ZIP 84646
Phone 435 436-5250
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 7/15/2025
Certificate Expiration Date 7/14/2027
Facility Type Rural Health Clinic
Lab Director EILEEN K. JACKSON

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