13D0520334 CLIA NUMBER - FAMILY PRACTICE GROUP, PA DBA INTERMOUNTAIN MEDICAL CLINIC

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Laboratory Demographics

CLIA Number: 13D0520334

Facility Name: FAMILY PRACTICE GROUP, PA DBA INTERMOUNTAIN MEDICAL CLINIC

Facility Address:
1951 BENCH RD #B
POCATELLO, ID
ZIP 83201
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Facility Phone Number: 208 238-1000

Facility Type: Physician Office

Certificate Type: Certificate of Compliance

NPI Number: 1205869310

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name	Field Value
CLIA Number	13D0520334
LAB Type	Physician Office
Facility Name	FAMILY PRACTICE GROUP, PA DBA INTERMOUNTAIN MEDICAL CLINIC
Street	1951 BENCH RD #B
City	POCATELLO
State	ID
ZIP	83201
Phone	208 238-1000
CertificateType	2
CertificateEffectiveDate	9/27/2022
CertificateExpirationDate	9/26/2024
FacilityType	Compliance

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