13D1026192 CLIA NUMBER - PCS PROCEDURE SUITE LLC

Laboratory Demographics

  • CLIA Code: 13D1026192
  • Facility Name: PCS PROCEDURE SUITE LLC
  • Facility Address: 110 VISTA DR
    POCATELLO, ID
    ZIP 83201
  • Facility Phone: 208 234-2300
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: MARK L. MANSFIELD
  • NPI Number: 1467979443
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 13D1026192
LAB Type Ambulatory Surgery Center
Facility Name PCS PROCEDURE SUITE LLC
Street 110 VISTA DR
City POCATELLO
State ID
ZIP 83201
Phone 208 234-2300
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/28/2024
Certificate Expiration Date 5/27/2026
Facility Type Ambulatory Surgery Center
Lab Director MARK L. MANSFIELD

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