46D2097163 CLIA NUMBER - LEGACY DERMATOLOGY

Laboratory Demographics

  • CLIA Code: 46D2097163
  • Facility Name: LEGACY DERMATOLOGY
  • Facility Address: 320 W 500 S SUITE 210
    BOUNTIFUL, UT
    ZIP 84010
  • Facility Phone: 801 797-9121
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: JARED R. HEATON
  • NPI Number: 1376944942
  • Taxonomy: 261QM2500X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 46D2097163
LAB Type Physician Office
Facility Name LEGACY DERMATOLOGY
Street 320 W 500 S SUITE 210
City BOUNTIFUL
State UT
ZIP 84010
Phone 801 797-9121
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 12/15/2023
Certificate Expiration Date 12/14/2025
Facility Type Physician Office
Lab Director JARED R. HEATON

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