Provider Demographics
NPI:1679964597
Name:STATE OF UTAH
Entity Type:Organization
Organization Name:STATE OF UTAH
Other - Org Name:UTAH PUBLIC HEALTH LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ATKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:801-965-2424
Mailing Address - Street 1:4431 S CONSTITUTION BLVD
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84129-8600
Mailing Address - Country:US
Mailing Address - Phone:801-965-2500
Mailing Address - Fax:
Practice Address - Street 1:4431 S CONSTITUTION BLVD
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84129-8600
Practice Address - Country:US
Practice Address - Phone:801-965-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-13
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory