13D0520354 CLIA NUMBER - PHYSICIANS IMMEDIATE CARE POCATELLO

Laboratory Demographics

  • CLIA Code: 13D0520354
  • Facility Name: PHYSICIANS IMMEDIATE CARE POCATELLO
  • Facility Address: 495 YELLOWSTONE AVE
    POCATELLO, ID
    ZIP 83201
  • Facility Phone: 208 478-7422
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: JAY WARREN WILLEY
  • NPI Number: 1700803632
  • Taxonomy: 261QU0200X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 13D0520354
LAB Type Physician Office
Facility Name PHYSICIANS IMMEDIATE CARE POCATELLO
Street 495 YELLOWSTONE AVE
City POCATELLO
State ID
ZIP 83201
Phone 208 478-7422
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 4/28/2025
Certificate Expiration Date 4/27/2027
Facility Type Physician Office
Lab Director JAY WARREN WILLEY

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