MEDICARE: MYRIAD GENETIC LABORATORIES, INC.

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	46D0880690	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	46D2094383	OTHER	UT	CLIA
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
14	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669484473
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MYRIAD GENETIC LABORATORIES, INC.

Provider Business Mailing Address
First Line	:	320 WAKARA WAY
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-1214
Country	:	US
Telephone Number	:	801-584-3600
Fax Number	:	801-883-3472

Provider Business Practice Location Address
First Line	:	322 N 2200 W
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84116-2922
Country	:	US
Telephone Number	:	801-584-3600
Fax Number	:	801-584-3615

Authorized Official
Title or Position	:	SR. VP PAYER MARKETS
Name	:	CHRISTOPHER D HO
Credential	:
Telephone Number	:	801-584-3600

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	01/27/2025

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