13D0927131 CLIA NUMBER - BAKER FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 13D0927131
  • Facility Name: BAKER FAMILY PRACTICE
  • Facility Address: 1880 JOHN ADAMS PKWY
    IDAHO FALLS, ID
    ZIP 83401
  • Facility Phone: 208 524-6633
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: WALLACE C. BAKER
  • NPI Number: 1134140148
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 13D0927131
LAB Type Physician Office
Facility Name BAKER FAMILY PRACTICE
Street 1880 JOHN ADAMS PKWY
City IDAHO FALLS
State ID
ZIP 83401
Phone 208 524-6633
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 11/9/2024
Certificate Expiration Date 11/8/2026
Facility Type Physician Office
Lab Director WALLACE C. BAKER

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