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General NPI Number Information
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NPI Number | 1457870990
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Entity Type | Organization
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Legal Business Name | SUMMIT LABORATORY SERVICES
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Dates
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Enumeration Date | 09/15/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1480 EAST 820 NORTH
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City | OREM
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State | UT
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Zip | 84097
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Country | US
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Telephone | 18018308541
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Fax |
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Provider Business Mailing Address
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Address Line | 1480 E 820 N
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City | OREM
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State | UT
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Zip | 84097-5481
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Country | US
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Telephone | 18018308541
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. TARA LYNN GLEAVE
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Credential | RN /DON
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Telephone | 801-830-8541
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0105X
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Taxonomy Name | Clinical Pathology/Laboratory Medicine Physician
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License Number |
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License Number State | UT
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