13D1047004 CLIA NUMBER - WEST FAMILY MEDICINE

Laboratory Demographics

CLIA Number: 13D1047004

Facility Name: WEST FAMILY MEDICINE

Facility Address:
1133 CALL CREEK PL #A
POCATELLO, ID
ZIP 83201
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Facility Phone Number: 208 232-1000

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1780808022

Taxonomy: 207QA0000X - Family Medicine
A family medicine physician with multidisciplinary training in the unique physical, psychological and social characteristics of adolescents and their health care problems and needs.

CLIA Record

Field Name	Field Value
CLIA Number	13D1047004
LAB Type	Physician Office
Facility Name	WEST FAMILY MEDICINE
Street	1133 CALL CREEK PL #A
City	POCATELLO
State	ID
ZIP	83201
Phone	208 232-1000
CertificateType	3
CertificateEffectiveDate	10/25/2023
CertificateExpirationDate	10/24/2025
FacilityType	PPMP

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