Organization
RED LAKE DIAGNOSTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICAH WOODWORTH (DIRECTOR)
(801) 669-3967
Entity
Organization
Contact information
Practice address
10 W BROADWAY, SUITE 710, SALT LAKE CITY, UT 84101-2002
(801) 669-3967
Mailing address
10 W BROADWAY, SUITE 710, SALT LAKE CITY, UT 84101-2002
(801) 669-3967
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Enumeration date
06/06/2014
Last updated
06/06/2014
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