46D2236698 CLIA NUMBER - LOGAN SURGERY CENTER, LLC

Laboratory Demographics

  • CLIA Code: 46D2236698
  • Facility Name: LOGAN SURGERY CENTER, LLC
  • Facility Address: 1350 NORTH 500 EAST
    LOGAN, UT
    ZIP 84341
  • Facility Phone: 801 507-9967
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: WESLEY MORTENSEN
  • NPI Number: 1063082980
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 46D2236698
LAB Type Ambulatory Surgery Center
Facility Name LOGAN SURGERY CENTER, LLC
Street 1350 NORTH 500 EAST
City LOGAN
State UT
ZIP 84341
Phone 801 507-9967
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/20/2025
Certificate Expiration Date 9/19/2027
Facility Type Ambulatory Surgery Center
Lab Director WESLEY MORTENSEN

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