Provider Demographics
NPI:1528022308
Name:RICHARDS LABORATORIES OF UTAH, INC.
Entity Type:Organization
Organization Name:RICHARDS LABORATORIES OF UTAH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-785-2500
Mailing Address - Street 1:55 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-2233
Mailing Address - Country:US
Mailing Address - Phone:801-785-2500
Mailing Address - Fax:801-785-2521
Practice Address - Street 1:3489 W 2100 S
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84119-1133
Practice Address - Country:US
Practice Address - Phone:801-978-2056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT46D1013214291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT46D1013214OtherCLIA NUMBER
UT990001972000Medicaid
UT990001972000Medicaid
UT000008042Medicare PIN