Provider Demographics
NPI:1154039436
Name:NATIONAL MOLECULAR DIAGNOSTICS
Entity type:Organization
Organization Name:NATIONAL MOLECULAR DIAGNOSTICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:STEELE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-336-8014
Mailing Address - Street 1:1955 W GROVE PKWY STE 201
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-6731
Mailing Address - Country:US
Mailing Address - Phone:385-248-0082
Mailing Address - Fax:
Practice Address - Street 1:1955 W GROVE PKWY STE 201
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-6731
Practice Address - Country:US
Practice Address - Phone:385-248-0082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-07
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT46D2270392OtherCLIA
UT52-1573280OtherCOLA