46D2246257 CLIA NUMBER - LIVING TREE MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 46D2246257
  • Facility Name: LIVING TREE MEDICAL GROUP
  • Facility Address: 169 N GATEWAY DRIVE, SUITE 170
    PROVIDENCE, UT
    ZIP 84332
  • Facility Phone: 435 565-6043
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MATTHEW J. WELTER
  • NPI Number: 1639754583
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 46D2246257
LAB Type Physician Office
Facility Name LIVING TREE MEDICAL GROUP
Street 169 N GATEWAY DRIVE, SUITE 170
City PROVIDENCE
State UT
ZIP 84332
Phone 435 565-6043
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/22/2023
Certificate Expiration Date 12/21/2025
Facility Type Physician Office
Lab Director MATTHEW J. WELTER

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