Healthcare Provider Details

I. General information

NPI: 1457870990
Provider Name (Legal Business Name): SUMMIT LABORATORY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1480 EAST 820 NORTH
OREM UT
84097
US

IV. Provider business mailing address

1480 E 820 N
OREM UT
84097-5481
US

V. Phone/Fax

Practice location:
  • Phone: 18018308541
  • Fax:
Mailing address:
  • Phone: 18018308541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number
License Number StateUT

VIII. Authorized Official

Name: MRS. TARA LYNN GLEAVE
Title or Position: CEO
Credential: RN /DON
Phone: 801-830-8541