13D0861110 CLIA NUMBER - PRIMARY HEALTH MEDICAL GROUP - MERIDIAN

Laboratory Demographics

  • CLIA Code: 13D0861110
  • Facility Name: PRIMARY HEALTH MEDICAL GROUP - MERIDIAN
  • Facility Address: 1648 NW 1ST STREET
    MERIDIAN, ID
    ZIP 83642
  • Facility Phone: 208 888-9393
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: MARK JOHNSON
  • NPI Number: 1407092794
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 13D0861110
LAB Type Physician Office
Facility Name PRIMARY HEALTH MEDICAL GROUP - MERIDIAN
Street 1648 NW 1ST STREET
City MERIDIAN
State ID
ZIP 83642
Phone 208 888-9393
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 9/9/2025
Certificate Expiration Date 9/8/2027
Facility Type Physician Office
Lab Director MARK JOHNSON

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