46D2095839 CLIA NUMBER - RIVERWOODS INTERVENTIONAL RADIOLOGY, INC DBA BLUE ROCK SURGICAL CENTER

Laboratory Demographics

  • CLIA Code: 46D2095839
  • Facility Name: RIVERWOODS INTERVENTIONAL RADIOLOGY, INC DBA BLUE ROCK SURGICAL CENTER
  • Facility Address: 3152 N UNIVERSITY AVE, SUITE 150
    PROVO, UT
    ZIP 84604
  • Facility Phone: (801) 229-2002
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: WENDELL A. GIBBY MD
  • NPI Number: 1649567504
  • Taxonomy: 261QM1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 46D2095839
LAB Type Ambulatory Surgery Center
Facility Name RIVERWOODS INTERVENTIONAL RADIOLOGY, INC DBA BLUE ROCK SURGICAL CENTER
Street 3152 N UNIVERSITY AVE, SUITE 150
City PROVO
State UT
ZIP 84604
Phone 8012292002
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/12/2025
Certificate Expiration Date 5/11/2027
Facility Type Ambulatory Surgery Center
Lab Director WENDELL A. GIBBY MD

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This page was last updated on: 5/18/2026