13D1063397 CLIA NUMBER - MERIDIAN PEDIATRICS PC

Laboratory Demographics

CLIA Number: 13D1063397

Facility Name: MERIDIAN PEDIATRICS PC

Facility Address:
3653 N LOCUST GROVE
MERIDIAN, ID
ZIP 83646
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Facility Phone Number: 208 338-5437

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1801919204

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	13D1063397
LAB Type	Physician Office
Facility Name	MERIDIAN PEDIATRICS PC
Street	3653 N LOCUST GROVE
City	MERIDIAN
State	ID
ZIP	83646
Phone	208 338-5437
CertificateType	4
CertificateEffectiveDate	11/19/2023
CertificateExpirationDate	11/18/2025
FacilityType	Waiver

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