46D2034725 CLIA NUMBER - HILLSIDE MEDICAL CLINIC LLC

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Laboratory Demographics

CLIA Number: 46D2034725

Facility Name: HILLSIDE MEDICAL CLINIC LLC

Facility Address:
112 NORTH MAIN STREET
SALEM, UT
ZIP 84653
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Facility Phone Number: 801 477-9007

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1770853962

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	46D2034725
LAB Type	Physician Office
Facility Name	HILLSIDE MEDICAL CLINIC LLC
Street	112 NORTH MAIN STREET
City	SALEM
State	UT
ZIP	84653
Phone	801 477-9007
CertificateType	4
CertificateEffectiveDate	1/3/2024
CertificateExpirationDate	1/2/2026
FacilityType	Waiver

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