46D2301785 CLIA NUMBER - INTERMOUNTAIN HEALTH SOUTHRIDGE CLINICS

Laboratory Demographics

  • CLIA Code: 46D2301785
  • Facility Name: INTERMOUNTAIN HEALTH SOUTHRIDGE CLINICS
  • Facility Address: 3723 W 12600 S SUITE 270A
    RIVERTON, UT
    ZIP 84065
  • Facility Phone: 801 285-4636
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: JAKE S. FREEMAN
  • NPI Number: 1154551919
  • Taxonomy: 282N00000X - General Acute Care Hospital

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 46D2301785
LAB Type Physician Office
Facility Name INTERMOUNTAIN HEALTH SOUTHRIDGE CLINICS
Street 3723 W 12600 S SUITE 270A
City RIVERTON
State UT
ZIP 84065
Phone 801 285-4636
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 4/1/2024
Certificate Expiration Date 3/31/2026
Facility Type Physician Office
Lab Director JAKE S. FREEMAN

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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