Red Lake Diagnostics

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

RED LAKE DIAGNOSTICS

Practice address

10 W Broadway
Suite 710
Salt Lake City, UT 84101-2002

Phone

(801) 669-3967

NPI assigned

Jun 6, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Micah Woodworth

Title

Director

Phone

(801) 669-3967

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1402012800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1402012800000",
    "number": "1982017919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 W BROADWAY",
            "address_2": "SUITE 710",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841012002",
            "telephone_number": "801-669-3967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 W BROADWAY",
            "address_2": "SUITE 710",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841012002",
            "telephone_number": "801-669-3967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RED LAKE DIAGNOSTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-06",
        "last_updated": "2014-06-06",
        "status": "A",
        "authorized_official_last_name": "WOODWORTH",
        "authorized_official_first_name": "MICAH",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "801-669-3967",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Clinical Medical Laboratory in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.