MEDICARE: REVEAL LABORATORIES LLC

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

General Provider Information

NPI Number	:	1205481363
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REVEAL LABORATORIES LLC

Provider Business Mailing Address
First Line	:	7370 S CREEK RD STE 204
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84093-6113
Country	:	US
Telephone Number	:	385-787-1380
Fax Number	:

Provider Business Practice Location Address
First Line	:	7370 S CREEK RD STE 204
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84093-6113
Country	:	US
Telephone Number	:	385-787-1380
Fax Number	:

Authorized Official
Title or Position	:	MANGER/MEMBER
Name	:	DR. DAVID ALLRED
Credential	:
Telephone Number	:	801-889-8291

Provider Enumeration Date	:	08/06/2019
Last Update Date	:	11/30/2020

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Directions to “REVEAL LABORATORIES LLC ” Practice Location

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