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46D2029241 CLIA NUMBER - BONNEVILLE FAMILY PRACTICE

Laboratory Demographics

CLIA Number: 46D2029241

Facility Name: BONNEVILLE FAMILY PRACTICE

Facility Address:
134 W 1180 N STE #5
TOOELE, UT
ZIP 84074
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Facility Phone Number: 801 983-2749

Facility Type: Physician Office

Certificate Type: Microscopy
NPI Number: 1861045189

Taxonomy: 251300000X - Local Education Agency (LEA)
The term local education agency means a public board of education or other public authority legally constituted within a State to either provide administrative control or direction of, or perform a service function for public schools serving individuals ages 0 - 21 in a state, city, county, township, school district, or other political subdivision including a combination of school districts or counties recognized in a State as an administrative agency for its public schools. An LEA may provide, or employ professional who provide, services to children included in the Individuals with Disabilities Education Act (IDEA), such services may include, but are not limited to, such medical services as physical, occupational, and speech therapy.

CLIA Record

Field Name Field Value
CLIA Number 46D2029241
LAB Type Physician Office
Facility Name BONNEVILLE FAMILY PRACTICE
Street 134 W 1180 N STE #5
City TOOELE
State UT
ZIP 84074
Phone 801 983-2749
CertificateType 3
CertificateEffectiveDate 9/1/2023
CertificateExpirationDate 8/31/2025
FacilityType PPMP

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