Organization
HEREDILAB, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELODY A. CAMPBELL (VICE PRESIDENT)
(801) 583-4123
Entity
Organization
Contact information
Practice address
1060 E 100 S STE 109, SALT LAKE CITY, UT 84102-4303
(801) 328-4254
(801) 328-9166
Mailing address
5505 E PIONEER FORK RD, SALT LAKE CITY, UT 84108-1682
(801) 558-8946
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE
—
Enumeration date
04/11/2019
Last updated
06/11/2019
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