13D1026192 CLIA NUMBER - PCS PROCEDURE SUITE LLC

Laboratory Demographics

CLIA Number: 13D1026192

Facility Name: PCS PROCEDURE SUITE LLC

Facility Address:
110 VISTA DR
POCATELLO, ID
ZIP 83201
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Facility Phone Number: (208) 234-2300

Facility Type: AMBULATORY SURGERY CENTER

Certificate Type: Waiver

NPI Number: 1467979443

Taxonomy: 261QA1903X - Clinic/Center

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

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This page was last updated on: 5/11/2023