13D0521010 CLIA NUMBER - REXBURG MEDICAL CENTER

Laboratory Demographics

  • CLIA Code: 13D0521010
  • Facility Name: REXBURG MEDICAL CENTER
  • Facility Address: 393 E 2ND NORTH
    REXBURG, ID
    ZIP 83440
  • Facility Phone: 208 356-5401
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: MATT TANNENBAUM
  • NPI Number: 1114010782
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 13D0521010
LAB Type Physician Office
Facility Name REXBURG MEDICAL CENTER
Street 393 E 2ND NORTH
City REXBURG
State ID
ZIP 83440
Phone 208 356-5401
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 8/11/2025
Certificate Expiration Date 8/10/2027
Facility Type Physician Office
Lab Director MATT TANNENBAUM

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