46D2320633 CLIA NUMBER - PEDIATRIC CARE

Laboratory Demographics

  • CLIA Code: 46D2320633
  • Facility Name: PEDIATRIC CARE
  • Facility Address: 89 EAST STATE RD 198, STE D
    SALEM, UT
    ZIP 84653
  • Facility Phone: 801 377-8000
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JOSHUA D. FULLER
  • NPI Number: 1811956352
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 46D2320633
LAB Type Physician Office
Facility Name PEDIATRIC CARE
Street 89 EAST STATE RD 198, STE D
City SALEM
State UT
ZIP 84653
Phone 801 377-8000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/21/2025
Certificate Expiration Date 3/20/2027
Facility Type Physician Office
Lab Director JOSHUA D. FULLER

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