02D2122130 CLIA NUMBER - IDEAL FAMILY MEDICINE

Laboratory Demographics

CLIA Number: 02D2122130

Facility Name: IDEAL FAMILY MEDICINE

Facility Address:
440A WEST EVERGREEN AVENUE
PALMER, AK
ZIP 99645
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Facility Phone Number: 907 746-3366

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1316489354

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	02D2122130
LAB Type	Physician Office
Facility Name	IDEAL FAMILY MEDICINE
Street	440A WEST EVERGREEN AVENUE
City	PALMER
State	AK
ZIP	99645
Phone	907 746-3366
CertificateType	4
CertificateEffectiveDate	11/21/2022
CertificateExpirationDate	11/20/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024