13D0982472 CLIA NUMBER - PORTNEUF ASC LLC DBA PORTNEUF ENDOSCOPY CENTER

Laboratory Demographics

  • CLIA Code: 13D0982472
  • Facility Name: PORTNEUF ASC LLC DBA PORTNEUF ENDOSCOPY CENTER
  • Facility Address: 1151 #A HOSPITAL WAY
    POCATELLO, ID
    ZIP 83201
  • Facility Phone: 208 232-6616
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: JONATHAN GODFREY
  • NPI Number: 1871016071
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 13D0982472
LAB Type Ambulatory Surgery Center
Facility Name PORTNEUF ASC LLC DBA PORTNEUF ENDOSCOPY CENTER
Street 1151 #A HOSPITAL WAY
City POCATELLO
State ID
ZIP 83201
Phone 208 232-6616
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/26/2025
Certificate Expiration Date 1/25/2027
Facility Type Ambulatory Surgery Center
Lab Director JONATHAN GODFREY

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