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Active NPI 1639560154 Organization (Entity Type 2)

Elysium Labsource

Physiological Laboratory • Bluffdale, UT

About Elysium Labsource NPI 1639560154 Summary

Elysium Labsource is a verified healthcare organization specializing in Physiological Laboratory operating in Bluffdale, UT. Located at 2435 W SPENCER CREST DR, this facility provides patient care and medical services under National Provider Identifier (NPI) 1639560154.

Administrative operations and authorized compliance are overseen by Michael Harris (Medical Director).

Facility Location & Contact Primary Location

Facility Address

2435 W Spencer Crest Dr

Bluffdale, UT 840653048

Telephone 8017099419

Authorized Official Information

Authorized Contact Name

Michael Harris , M.D.

Title / Role

Medical Director

Official Telephone

8014658004

Facility Classifications & Specialties

Physiological Laboratory Primary Taxonomy

NUCC Taxonomy Code: 293D00000X

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.

Facility & Registry History Timeline

Chronological log of verified NPI organization updates, branch relocations, and registry updates

6 Historical Events
NPI Profile Active March 01, 2015

NPI status registered as active in NPPES database

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Updated Practice Location March 01, 2015

Registered at 2435 W SPENCER CREST DR, BLUFFDALE, UT 840653048 (Tel: 8017099419)

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Updated Business Mailing Address March 01, 2015

Registered at 2435 W SPENCER CREST DR, BLUFFDALE, UT 840653048

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Organization / Clinic Name Updated March 01, 2015

Operating as ELYSIUM LABSOURCE

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Medical Taxonomy / Specialty Registered (Primary Specialty) March 01, 2015

Physiological Laboratory (License #46D2091373 in UT)

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Initial NPI Registration & Enumeration February 06, 2015

First registered as active Healthcare Organization in NPPES Database.

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NPI Organization Metadata

NPI Number: 1639560154
Entity Type:
Organization Organization (Hospital, Clinic, Group Practice) (Type 2 NPI)
Enumeration Date: February 06, 2015
Last Update: March 01, 2015

Mailing Address

2435 W Spencer Crest Dr

Bluffdale, UT 840653048

Public Domain Record This organization profile is sourced from public domain datasets published by CMS and NPPES under FOIA.
⚠️ Medical Disclaimer

Facility details are provided for public information only. In case of a medical emergency, call 911 immediately.