13D1003406 CLIA NUMBER - PIONEER FAMILY MEDICINE

Laboratory Demographics

CLIA Number: 13D1003406

Facility Name: PIONEER FAMILY MEDICINE

Facility Address:
4740 N PENNGROVE WAY STE 100
MERIDIAN, ID
ZIP 83646
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Facility Phone Number: 208 938-3663

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1952335929

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name	Field Value
CLIA Number	13D1003406
LAB Type	Physician Office
Facility Name	PIONEER FAMILY MEDICINE
Street	4740 N PENNGROVE WAY STE 100
City	MERIDIAN
State	ID
ZIP	83646
Phone	208 938-3663
CertificateType	4
CertificateEffectiveDate	11/2/2022
CertificateExpirationDate	11/1/2024
FacilityType	Waiver

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