46D2174672 CLIA NUMBER - MOUNTAINSTAR OGDEN PEDIATRICS

Laboratory Demographics

  • CLIA Code: 46D2174672
  • Facility Name: MOUNTAINSTAR OGDEN PEDIATRICS
  • Facility Address: 1741 N 2000 W , STE 3
    FARR WEST, UT
    ZIP 84404
  • Facility Phone: 801 479-0174
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MICHAEL SEVERANCE
  • NPI Number: 1265694509
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 46D2174672
LAB Type Physician Office
Facility Name MOUNTAINSTAR OGDEN PEDIATRICS
Street 1741 N 2000 W , STE 3
City FARR WEST
State UT
ZIP 84404
Phone 801 479-0174
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/6/2023
Certificate Expiration Date 11/5/2025
Facility Type Physician Office
Lab Director MICHAEL SEVERANCE

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