13D0927132 CLIA NUMBER - HIGH VALLEY DERMATOLOGY AND DERMATOLOGIC SURGERY PLLC

Laboratory Demographics

  • CLIA Code: 13D0927132
  • Facility Name: HIGH VALLEY DERMATOLOGY AND DERMATOLOGIC SURGERY PLLC
  • Facility Address: 2085 PROVIDENCE WAY
    IDAHO FALLS, ID
    ZIP 83404
  • Facility Phone: 208 535-4888
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: BRANDON L. MINER
  • NPI Number: 1255449898
  • Taxonomy: 207ND0101X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 13D0927132
LAB Type Physician Office
Facility Name HIGH VALLEY DERMATOLOGY AND DERMATOLOGIC SURGERY PLLC
Street 2085 PROVIDENCE WAY
City IDAHO FALLS
State ID
ZIP 83404
Phone 208 535-4888
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 12/2/2023
Certificate Expiration Date 12/1/2025
Facility Type Physician Office
Lab Director BRANDON L. MINER

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