46D1105927 CLIA NUMBER - JERRY & KATHLEEN GRUNDHOFER CLINIC

Laboratory Demographics

  • CLIA Code: 46D1105927
  • Facility Name: JERRY & KATHLEEN GRUNDHOFER CLINIC
  • Facility Address: 900 ROUND VALLEY DRIVE STE 200
    PARK CITY, UT
    ZIP 84060
  • Facility Phone: 435 658-7400
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DONALD J. BRUST
  • NPI Number: 1770899072
  • Taxonomy: 208M00000X - Hospitalist

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CLIA Record

Field Name Field Value
CLIA Number 46D1105927
LAB Type Physician Office
Facility Name JERRY & KATHLEEN GRUNDHOFER CLINIC
Street 900 ROUND VALLEY DRIVE STE 200
City PARK CITY
State UT
ZIP 84060
Phone 435 658-7400
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 10/1/2025
Certificate Expiration Date 9/30/2027
Facility Type Physician Office
Lab Director DONALD J. BRUST

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