Organization
BALLARD MEDICAL PRODUCTS
Active
Other names
Ballard Medical Laboratory Services
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIMOTHY D DYE (GENERAL MANAGER)
(801) 572-6800
Entity
Organization
Contact information
Practice address
12050 LONE PEAK PKWY, DRAPER, UT 84020-9414
(801) 572-6800
Mailing address
12050 LONE PEAK PKWY, DRAPER, UT 84020-9414
(801) 572-6800
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
LN-2003-0038
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2277628
AETNA
—
01
—
7494105
AETNA
—
01
—
A1960874
OXFORD HEALTH PLAN
—
Enumeration date
08/19/2005
Last updated
08/22/2020
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