46D2192438 CLIA NUMBER - BE WELL MEDICAL, PLLC

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Laboratory Demographics

CLIA Number: 46D2192438

Facility Name: BE WELL MEDICAL, PLLC

Facility Address:
3935 N 75 W
HYDE PARK, UT
ZIP 84318
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Facility Phone Number: 435 359-0720

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1669092169

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	46D2192438
LAB Type	Practitioner Other
Facility Name	BE WELL MEDICAL, PLLC
Street	3935 N 75 W
City	HYDE PARK
State	UT
ZIP	84318
Phone	435 359-0720
CertificateType	4
CertificateEffectiveDate	9/10/2022
CertificateExpirationDate	9/9/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024