13D1065502 CLIA NUMBER - UPPER VALLEY ENT & ALLERGY

Laboratory Demographics

CLIA Number: 13D1065502

Facility Name: UPPER VALLEY ENT & ALLERGY

Facility Address:
256 N 2ND E
REXBURG, ID
ZIP 83440
Get Directions

Facility Phone Number: 208 656-9646

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1124462494

Taxonomy: 207YX0905X - Otolaryngology
An otolaryngologist who specializes in the diagnosis and surgical treatment of head and neck conditions.

CLIA Record

Field Name	Field Value
CLIA Number	13D1065502
LAB Type	Physician Office
Facility Name	UPPER VALLEY ENT & ALLERGY
Street	256 N 2ND E
City	REXBURG
State	ID
ZIP	83440
Phone	208 656-9646
CertificateType	4
CertificateEffectiveDate	3/2/2023
CertificateExpirationDate	3/1/2025
FacilityType	Waiver

Download Record

Export to text format icon Download this CLIA NUMBER record in Text format: Export

Export to text format icon Download this CLIA NUMBER record in Excel (CSV) format: Export

Export to text format icon Download this CLIA NUMBER record in XML format: Export

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