13D0914355 CLIA NUMBER - PHYSICIANS IMMEDIATE CARE CENTER

Laboratory Demographics

CLIA Number: 13D0914355

Facility Name: PHYSICIANS IMMEDIATE CARE CENTER

Facility Address:
243 CHENEY DR WEST STE 200
TWIN FALLS, ID
ZIP 83301
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Facility Phone Number: 208 736-7422

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1114141090

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	13D0914355
LAB Type	Physician Office
Facility Name	PHYSICIANS IMMEDIATE CARE CENTER
Street	243 CHENEY DR WEST STE 200
City	TWIN FALLS
State	ID
ZIP	83301
Phone	208 736-7422
CertificateType	3
CertificateEffectiveDate	6/11/2022
CertificateExpirationDate	6/10/2024
FacilityType	PPMP

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