46D2303966 CLIA NUMBER - EAST LOGAN CLINIC - FAMILY MEDICINE

Laboratory Demographics

  • CLIA Code: 46D2303966
  • Facility Name: EAST LOGAN CLINIC - FAMILY MEDICINE
  • Facility Address: 550 EAST 1400 NORTH SUITE XY
    LOGAN, UT
    ZIP 84341
  • Facility Phone: 435 716-1701
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RYAN W. ALLEN
  • NPI Number: 1841386406
  • Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies

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CLIA Record

Field Name Field Value
CLIA Number 46D2303966
LAB Type Physician Office
Facility Name EAST LOGAN CLINIC - FAMILY MEDICINE
Street 550 EAST 1400 NORTH SUITE XY
City LOGAN
State UT
ZIP 84341
Phone 435 716-1701
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/19/2025
Certificate Expiration Date 5/18/2027
Facility Type Physician Office
Lab Director RYAN W. ALLEN

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