13D0994767 CLIA NUMBER - IDAHO PHYSICIANS CLINIC

Laboratory Demographics

  • CLIA Code: 13D0994767
  • Facility Name: IDAHO PHYSICIANS CLINIC
  • Facility Address: 98 POPLAR ST
    BLACKFOOT, ID
    ZIP 83221
  • Facility Phone: 208 785-3800
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: THOMAS CALL
  • NPI Number: 1770785875
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 13D0994767
LAB Type Physician Office
Facility Name IDAHO PHYSICIANS CLINIC
Street 98 POPLAR ST
City BLACKFOOT
State ID
ZIP 83221
Phone 208 785-3800
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 1/15/2025
Certificate Expiration Date 1/14/2027
Facility Type Physician Office
Lab Director THOMAS CALL

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