13D1056608 CLIA NUMBER - MOUNTAIN WEST DERMATOLOGY

Laboratory Demographics

  • CLIA Code: 13D1056608
  • Facility Name: MOUNTAIN WEST DERMATOLOGY
  • Facility Address: 3425 S MERLIN DR #200
    IDAHO FALLS, ID
    ZIP 83404
  • Facility Phone: 208 528-6653
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: MARK E. HINKSON
  • NPI Number: 1437210994
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 13D1056608
LAB Type Physician Office
Facility Name MOUNTAIN WEST DERMATOLOGY
Street 3425 S MERLIN DR #200
City IDAHO FALLS
State ID
ZIP 83404
Phone 208 528-6653
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 7/20/2024
Certificate Expiration Date 7/19/2026
Facility Type Physician Office
Lab Director MARK E. HINKSON

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