13D0922939 CLIA NUMBER - ST LUKE'S CLINIC - TRINITY MOUNTAIN

Laboratory Demographics

CLIA Number: 13D0922939

Facility Name: ST LUKE'S CLINIC - TRINITY MOUNTAIN

Facility Address:
465 MCKENNA DR
MOUNTAIN HOME, ID
ZIP 83647
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Facility Phone Number: 208 587-9703

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1417297821

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	13D0922939
LAB Type	Physician Office
Facility Name	ST LUKE'S CLINIC - TRINITY MOUNTAIN
Street	465 MCKENNA DR
City	MOUNTAIN HOME
State	ID
ZIP	83647
Phone	208 587-9703
CertificateType	3
CertificateEffectiveDate	12/10/2022
CertificateExpirationDate	12/9/2024
FacilityType	PPMP

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