ELYSIUM LABSOURCE (NPI# 1639560154) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639560154 |
| Entity Type | Organization |
| Organization Name | ELYSIUM LABSOURCE |
| Other Organization Name | ELYSIUM LABORATORY SERVICE |
| Practice Address |
2435 W Spencer Crest Dr Bluffdale UT 84065-3048 |
| Practice Telephone | 8017099419 |
| Enumeration Date | 2015-02-06 |
| Last Update Date | 2015-03-01 |
| Authorized Official Name | MICHAEL HARRIS (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 8014658004 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 293D00000X | Physiological Laboratory | 46D2091373 | UT | Laboratories |
| Other Name | Type Code |
|---|---|
| Elysium Laboratory Service | Other Name - Individual/Organization |
| Street Address |
2435 W SPENCER CREST DR |
| City | BLUFFDALE |
| State | UT |
| Zip Code | 84065-3048 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437544145 | Arcadia Residential Treatment Centers Inc. | Counselor | 2435 W Spencer Crest Dr, Bluffdale, UT 84065-3048 | 2015-03-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659972248 | William Lance Andersen | Pharmacist | 1202 W 12600 W, Riverton, UT 84065 | 2020-11-02 |
| 1275172678 | Dentists of Riverton, LLP | Dentist | 4531 W. Partridgehill Lane, Suite F-110, Riverton, UT 84065 | 2020-01-02 |
| 1194201467 | Patrick Kunkel | Dentist | 12569 2700 W, #100, Riverton, UT 84065 | 2018-07-19 |
| 1790274546 | Harmon City Inc | Pharmacy | 13330 South Kestrel Range Road, Riverton, UT 84065 | 2018-05-08 |
| 1386147767 | Richard Hayes Johnston | Counselor | 3740 S Market Center Dr #1200, Riverton, UT 84065 | 2018-03-13 |
| 1023537156 | Brenda Fuell | Dental Hygienist | 12959 South Picket Fence Lane, Riverton, UT 84065 | 2017-09-09 |
| 1407373426 | Bethany Marie Breck | Counselor | 3740 S Market Center Drive, #1200, Riverton, UT 84065 | 2017-08-30 |
| 1952848509 | Renaissance Ranch Bluffdale Women's Program | Substance Abuse Rehabilitation Facility | 2356 Thunderhead Way, Bluffdale, UT 84065 | 2017-01-20 |
| 1053856229 | Bradford Scott Bentley Jr. | Physical Therapist | 3741 W 12600 S, Ste 100, Riverton, UT 84065 | 2016-12-27 |
| 1194273524 | New Horizon | Preferred Provider Organization | 1420 W 12600 Sputh, Draper, UT 84065 | 2016-09-14 |
| Find all providers in zip 84065 | ||||
| Taxonomy Code | 293D00000X |
| Grouping | Laboratories |
| Classification | Physiological Laboratory |
| A laboratory that operates independently of a hospital and physician’s office to furnish physiological diagnostic services (e.g. EEG’s , EKG’s, scans, etc.). Facilities offering ONLY physiological services are not certified as independent laboratories. If an independent laboratory offers physiological services IN ADDITION to clinical laboratory services, they are surveyed only for compliance with the clinical laboratory regulations because there are no health and safety regulations for physiological services. |
| Notes: Source: Paraphrased from the Medicare Carrier Manual, Section 2070.5. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740752500 | Stream Dx Inc | Physiological Laboratory | 2305 S 1070 W, West Valley City, UT 84119-1564 | 2018-12-18 |
| 1316425432 | East Side Imaging, LLC | Physiological Laboratory | 3702 S State St Ste 111, Salt Lake City, UT 84115-5078 | 2018-07-31 |
| 1437671583 | Kg Medical Consulting | Physiological Laboratory | 231 E 200 N, American Fork, UT 84003-1742 | 2017-07-11 |
| 1407187701 | Monitoring Associates | Physiological Laboratory | 1817 W 800 N, Salt Lake City, UT 84025 | 2010-01-26 |
| 1194930495 | Brigham Young University | Physiological Laboratory | Y Be Fit, 127 Richards Building, Brigham Young University, Provo, UT 84602 | 2007-05-11 |
| 1235188608 | Diagnostic Health Corporation | Physiological Laboratory | 1850 Sidewinder Dr, Suite 410, Park City, UT 84060-7471 | 2006-05-10 |
| 1174526107 | Open Imaging Layton LLC | Physiological Laboratory | 2071 N Main St, Ste 100, Layton, UT 84041-4969 | 2005-05-23 |
| 1366445397 | Open Imaging Lc | Physiological Laboratory | 6243 S Redwood Rd, Ste 130, Taylorsville, UT 84123-6408 | 2005-05-23 |
| 1477921112 | Jml Lab Solutions | Physiological Laboratory | 10965 S State St, Sandy, UT 84070-4270 | 2015-09-11 |
| 1811374390 | Logan Sleep Diagnostics, Inc | Physiological Laboratory | 1395 N 400 E, Suite C, Logan, UT 84341-7530 | 2015-05-04 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.