13D0999409 CLIA NUMBER - INTERMOUNTAIN MEDICAL IMAGING

Laboratory Demographics

  • CLIA Code: 13D0999409
  • Facility Name: INTERMOUNTAIN MEDICAL IMAGING
  • Facility Address: 2929 E MAGIC VIEW DR
    MERIDIAN, ID
    ZIP 83642
  • Facility Phone: (208) 954-8030
  • Facility Type: Other - OP RADIOLOGY IMAGING CTR
  • Facility Type: Waiver
  • Lab Director: BENJAMIN K. HOM
  • NPI Number: 1598524696
  • Taxonomy: 2085R0202X - Radiology

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CLIA Record

Field Name Field Value
CLIA Number 13D0999409
LAB Type Other - OP RADIOLOGY IMAGING CTR
Facility Name INTERMOUNTAIN MEDICAL IMAGING
Street 2929 E MAGIC VIEW DR
City MERIDIAN
State ID
ZIP 83642
Phone 2089548030
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/26/2024
Certificate Expiration Date 8/25/2026
Facility Type Other - OP RADIOLOGY IMAGING CTR
Lab Director BENJAMIN K. HOM

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This page was last updated on: 5/18/2026