46D2062319 CLIA NUMBER - MOUNTAIN WEST MEDICAL GROUP PEDIATRICS

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Laboratory Demographics

CLIA Number: 46D2062319

Facility Name: MOUNTAIN WEST MEDICAL GROUP PEDIATRICS

Facility Address:
196 E 2000 N SUITE 104
TOOELE, UT
ZIP 84074
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Facility Phone Number: 435 882-9035

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1487652608

Taxonomy: 2085R0202X - Radiology
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.

CLIA Record

Field Name	Field Value
CLIA Number	46D2062319
LAB Type	Physician Office
Facility Name	MOUNTAIN WEST MEDICAL GROUP PEDIATRICS
Street	196 E 2000 N SUITE 104
City	TOOELE
State	UT
ZIP	84074
Phone	435 882-9035
CertificateType	4
CertificateEffectiveDate	7/15/2023
CertificateExpirationDate	7/14/2025
FacilityType	Waiver

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