13D0520361 CLIA NUMBER - PORTNEUF MEDICAL CENTER

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Laboratory Demographics

CLIA Number: 13D0520361

Facility Name: PORTNEUF MEDICAL CENTER

Facility Address:
777 HOSPITAL WAY
POCATELLO, ID
ZIP 83201
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Facility Phone Number: 208 239-1671

Facility Type: Hospital

Certificate Type: Accreditation

NPI Number: 1871016071

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	13D0520361
LAB Type	Hospital
Facility Name	PORTNEUF MEDICAL CENTER
Street	777 HOSPITAL WAY
City	POCATELLO
State	ID
ZIP	83201
Phone	208 239-1671
CertificateType	1
CertificateEffectiveDate	1/3/2023
CertificateExpirationDate	1/2/2025
FacilityType	Accreditation

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