Organization
WESTERN BIOLOGICAL LABORATORY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WAYNE R BURT PH.D. (LABORATORY DIRECTOR)
(801) 278-9206
Entity
Organization
Contact information
Practice address
2180 E 4500 S, SUITE 292, SALT LAKE CITY, UT 84117-4434
(801) 278-9206
(801) 278-9287
Mailing address
2180 E 4500 S, SUITE 292, SALT LAKE CITY, UT 84117-4434
(801) 278-9206
(801) 278-9287
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
46D0865144
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
46D0865144
CLIA NUMBER
UT
Enumeration date
03/22/2007
Last updated
11/13/2014
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