46D2237201 CLIA NUMBER - BEAR LAKE COMMUNITY HEALTH CENTER - RANDOLPH

Laboratory Demographics

CLIA Number: 46D2237201

Facility Name: BEAR LAKE COMMUNITY HEALTH CENTER - RANDOLPH

Facility Address:
120 SOUTH MAIN STREET
RANDOLPH, UT
ZIP 84064
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Facility Phone Number: 435 946-3660

Facility Type: Federally Qualified Health Center

Certificate Type: Microscopy

NPI Number: 1689241762

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	46D2237201
LAB Type	Federally Qualified Health Center
Facility Name	BEAR LAKE COMMUNITY HEALTH CENTER - RANDOLPH
Street	120 SOUTH MAIN STREET
City	RANDOLPH
State	UT
ZIP	84064
Phone	435 946-3660
CertificateType	3
CertificateEffectiveDate	9/23/2023
CertificateExpirationDate	9/22/2025
FacilityType	PPMP

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