46D2136657 CLIA NUMBER - FJM MEDICAL CLINIC BASECAMP

Laboratory Demographics

  • CLIA Code: 46D2136657
  • Facility Name: FJM MEDICAL CLINIC BASECAMP
  • Facility Address: 185 S STATE STREET, SUITE 208
    SALT LAKE CITY, UT
    ZIP 84111
  • Facility Phone: 801 821-5454
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: TIMOTHY YOUNG
  • NPI Number: 1255858734
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 46D2136657
LAB Type Physician Office
Facility Name FJM MEDICAL CLINIC BASECAMP
Street 185 S STATE STREET, SUITE 208
City SALT LAKE CITY
State UT
ZIP 84111
Phone 801 821-5454
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 4/23/2024
Certificate Expiration Date 4/22/2026
Facility Type Physician Office
Lab Director TIMOTHY YOUNG

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