46D2175159 CLIA NUMBER - KELLY HUBBARD, MD-CACHE VALLEY DERMATOLOGY

Laboratory Demographics

  • CLIA Code: 46D2175159
  • Facility Name: KELLY HUBBARD, MD-CACHE VALLEY DERMATOLOGY
  • Facility Address: 530 W 465 N, SUITE 701
    PROVIDENCE, UT
    ZIP 84332
  • Facility Phone: 435 752-5741
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: KELLY W. HUBBARD
  • NPI Number: 1770779985
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 46D2175159
LAB Type Physician Office
Facility Name KELLY HUBBARD, MD-CACHE VALLEY DERMATOLOGY
Street 530 W 465 N, SUITE 701
City PROVIDENCE
State UT
ZIP 84332
Phone 435 752-5741
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 11/18/2023
Certificate Expiration Date 11/17/2025
Facility Type Physician Office
Lab Director KELLY W. HUBBARD

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