13D0975616 CLIA NUMBER - FALLS CENTRE FOR FUNCTIONAL MEDICINE PLLC

Laboratory Demographics

  • CLIA Code: 13D0975616
  • Facility Name: FALLS CENTRE FOR FUNCTIONAL MEDICINE PLLC
  • Facility Address: 236 MARTIN ST
    TWIN FALLS, ID
    ZIP 83301
  • Facility Phone: 208 733-4444
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: LAURENCE V. HICKS
  • NPI Number: 1962916304
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 13D0975616
LAB Type Physician Office
Facility Name FALLS CENTRE FOR FUNCTIONAL MEDICINE PLLC
Street 236 MARTIN ST
City TWIN FALLS
State ID
ZIP 83301
Phone 208 733-4444
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 7/12/2024
Certificate Expiration Date 7/11/2026
Facility Type Physician Office
Lab Director LAURENCE V. HICKS

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