46D0861702 CLIA NUMBER - INTERMOUNTAIN MEDICAL CENTER DIALYSIS SERVICES

Laboratory Demographics

  • CLIA Code: 46D0861702
  • Facility Name: INTERMOUNTAIN MEDICAL CENTER DIALYSIS SERVICES
  • Facility Address: 74 WEST VINE STREET
    MURRAY, UT
    ZIP 84107
  • Facility Phone: 801 507-9000
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: GOPAL CHEMITI
  • NPI Number: 1083768071
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 46D0861702
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name INTERMOUNTAIN MEDICAL CENTER DIALYSIS SERVICES
Street 74 WEST VINE STREET
City MURRAY
State UT
ZIP 84107
Phone 801 507-9000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director GOPAL CHEMITI

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This page was last updated on: 6/4/2025