MEDICARE: NATIONAL MOLECULAR DIAGNOSTICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	46D2270392	OTHER	UT	CLIA
2	52-1573280	OTHER	UT	COLA

General Provider Information

NPI Number	:	1154039436
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATIONAL MOLECULAR DIAGNOSTICS

Provider Business Mailing Address
First Line	:	1955 W GROVE PKWY STE 201
Second Line	:
City	:	PLEASANT GROVE
State	:	UT
Zip	:	84062-6731
Country	:	US
Telephone Number	:	385-248-0082
Fax Number	:

Provider Business Practice Location Address
First Line	:	1955 W GROVE PKWY STE 201
Second Line	:
City	:	PLEASANT GROVE
State	:	UT
Zip	:	84062-6731
Country	:	US
Telephone Number	:	385-248-0082
Fax Number	:

Authorized Official
Title or Position	:	VP OF OPERATIONS
Name	:	STEELE ANDERSON
Credential	:
Telephone Number	:	801-336-8014

Provider Enumeration Date	:	11/07/2022
Last Update Date	:	02/27/2023

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Directions to “NATIONAL MOLECULAR DIAGNOSTICS ” Practice Location

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