13D0935096 CLIA NUMBER - PRIMARY CARE SPECIALISTS PA

Laboratory Demographics

CLIA Number: 13D0935096

Facility Name: PRIMARY CARE SPECIALISTS PA

Facility Address:
110 VISTA DR
POCATELLO, ID
ZIP 83201
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Facility Phone Number: 208 234-2300

Facility Type: Physician Office

Certificate Type: Certificate of Compliance

NPI Number: 1508875881

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	13D0935096
LAB Type	Physician Office
Facility Name	PRIMARY CARE SPECIALISTS PA
Street	110 VISTA DR
City	POCATELLO
State	ID
ZIP	83201
Phone	208 234-2300
CertificateType	2
CertificateEffectiveDate	10/28/2022
CertificateExpirationDate	10/27/2024
FacilityType	Compliance

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