13D1008049 CLIA NUMBER - GENESIS COMMUNITY CLINIC

Laboratory Demographics

CLIA Number: 13D1008049

Facility Name: GENESIS COMMUNITY CLINIC

Facility Address:
215 W 35TH
GARDEN CITY, ID
ZIP 83714
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Facility Phone Number: 208 384-5200

Facility Type: Community Clinic

Certificate Type: Waiver

NPI Number: 1548783160

Taxonomy: 251V00000X - Voluntary or Charitable

CLIA Record

Field Name	Field Value
CLIA Number	13D1008049
LAB Type	Community Clinic
Facility Name	GENESIS COMMUNITY CLINIC
Street	215 W 35TH
City	GARDEN CITY
State	ID
ZIP	83714
Phone	208 384-5200
CertificateType	4
CertificateEffectiveDate	8/19/2022
CertificateExpirationDate	8/18/2024
FacilityType	Waiver

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