Healthcare Provider Details

I. General information

NPI: 1043122179
Provider Name (Legal Business Name): BEECON RECOVERY LAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 S MAIN ST
BRIGHAM CITY UT
84302-6719
US

IV. Provider business mailing address

60 S MAIN ST
BRIGHAM CITY UT
84302-6719
US

V. Phone/Fax

Practice location:
  • Phone: 435-239-8768
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANTHONY POOL
Title or Position: OWNER
Credential:
Phone: 435-239-8768