46D2296258 CLIA NUMBER - MOUNTAIN AMERICA HEALTH CLINIC

Laboratory Demographics

CLIA Number: 46D2296258

Facility Name: MOUNTAIN AMERICA HEALTH CLINIC

Facility Address:
9800 S MONROE ST, UNIT FL 1
SANDY, UT
ZIP 84070
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Facility Phone Number: 802 857-0400

Facility Type: Other - ONSITE HEALTH CENTER

Certificate Type: Waiver

NPI Number: 1720054828

Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies
A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.

CLIA Record

Field Name	Field Value
CLIA Number	46D2296258
LAB Type	Other - ONSITE HEALTH CENTER
Facility Name	MOUNTAIN AMERICA HEALTH CLINIC
Street	9800 S MONROE ST, UNIT FL 1
City	SANDY
State	UT
ZIP	84070
Phone	802 857-0400
CertificateType	4
CertificateEffectiveDate	12/26/2023
CertificateExpirationDate	12/25/2025
FacilityType	Waiver

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