Basic Information
| Provider Information | |||||||||
| NPI: | 1154794139 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CPF RECOVERY WAYS LAB | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4848 S COMMERCE DR | ||||||||
| Address2: | |||||||||
| City: | MURRAY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841074761 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8012936100 | ||||||||
| FaxNumber: | 8012662320 | ||||||||
| Practice Location | |||||||||
| Address1: | 4050 S HOWICK ST | ||||||||
| Address2: | SUITE 11E | ||||||||
| City: | MURRAY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841071448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8012936100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2015 | ||||||||
| LastUpdateDate: | 11/12/2015 | ||||||||
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| AuthorizedOfficialLastName: | ROSENTHAL | ||||||||
| AuthorizedOfficialFirstName: | MARYANN | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXEC. DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8012936100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PH.D | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | 57094 | UT | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.