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General NPI Number Information
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NPI Number | 1306449723
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Entity Type | Organization
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Legal Business Name | ADVANCED CLINICAL LABORATORY
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Dates
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Enumeration Date | 11/18/2020
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Last Update Date | 11/18/2020
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Provider Practice Location Address
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Address Line | 1272 W HIGHWAY 40
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City | VERNAL
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State | UT
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Zip | 84078-2925
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Country | US
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Telephone | 435-781-0660
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Fax | 435-781-0661
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Provider Business Mailing Address
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Address Line | 1272 W HIGHWAY 40
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City | VERNAL
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State | UT
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Zip | 84078-2925
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Country | US
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Telephone | 435-781-0660
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Fax | 435-781-0661
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Authorized Official
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Title or Position | MEMBER
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Name | DR. TYLER SHINER
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Credential | DDS
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Telephone | 435-781-0660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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