46D2275767 CLIA NUMBER - BOUNTIFUL CLINIC

Laboratory Demographics

  • CLIA Code: 46D2275767
  • Facility Name: BOUNTIFUL CLINIC
  • Facility Address: 390 N MAIN ST, DEPT 73104
    BOUNTIFUL, UT
    ZIP 84010
  • Facility Phone: 801 397-6400
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: ALISA A. KNOWLTON
  • NPI Number: 1801168794
  • Taxonomy: 367500000X - Nurse Anesthetist, Certified Registered

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CLIA Record

Field Name Field Value
CLIA Number 46D2275767
LAB Type Physician Office
Facility Name BOUNTIFUL CLINIC
Street 390 N MAIN ST, DEPT 73104
City BOUNTIFUL
State UT
ZIP 84010
Phone 801 397-6400
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 1/27/2025
Certificate Expiration Date 1/26/2027
Facility Type Physician Office
Lab Director ALISA A. KNOWLTON

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