46D2272293 CLIA NUMBER - AMERICAN FORK SPECIALTY CLINIC - DERMATOLOGY

Laboratory Demographics

  • CLIA Code: 46D2272293
  • Facility Name: AMERICAN FORK SPECIALTY CLINIC - DERMATOLOGY
  • Facility Address: 98 N 1100 E, #301
    AMERICAN FORK, UT
    ZIP 84003
  • Facility Phone: 801 492-2300
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: KIMBERLY A. PETTIT
  • NPI Number: 1265549984
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 46D2272293
LAB Type Physician Office
Facility Name AMERICAN FORK SPECIALTY CLINIC - DERMATOLOGY
Street 98 N 1100 E, #301
City AMERICAN FORK
State UT
ZIP 84003
Phone 801 492-2300
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 11/17/2024
Certificate Expiration Date 11/16/2026
Facility Type Physician Office
Lab Director KIMBERLY A. PETTIT

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