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General NPI Number Information
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NPI Number | 1679964597
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Entity Type | Organization
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Legal Business Name | STATE OF UTAH
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Dates
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Enumeration Date | 02/13/2015
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Last Update Date | 02/13/2015
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Provider Practice Location Address
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Address Line | 4431 S CONSTITUTION BLVD
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City | TAYLORSVILLE
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State | UT
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Zip | 84129-8600
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Country | US
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Telephone | 801-965-2500
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Fax |
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Provider Business Mailing Address
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Address Line | 4431 S CONSTITUTION BLVD
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City | TAYLORSVILLE
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State | UT
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Zip | 84129-8600
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Country | US
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Telephone | 801-965-2500
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. ROBYN M ATKINSON
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Credential | PHD
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Telephone | 801-965-2424
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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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