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

Laboratory Demographics

  • CLIA Code: 13D0520334
  • Facility Name: FAMILY PRACTICE GROUP, PA DBA INTERMOUNTAIN MEDICAL CLINIC
  • Facility Address: 1951 BENCH RD #B
    POCATELLO, ID
    ZIP 83201
  • Facility Phone: 208 238-1000
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: ANDREW THAYNE
  • NPI Number: 1205869310
  • Taxonomy: 207Q00000X - Family Medicine

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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
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 9/27/2024
Certificate Expiration Date 9/26/2026
Facility Type Physician Office
Lab Director ANDREW THAYNE

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This page was last updated on: 9/29/2025