13D1065502 CLIA NUMBER - UPPER VALLEY ENT & ALLERGY

Laboratory Demographics

  • CLIA Code: 13D1065502
  • Facility Name: UPPER VALLEY ENT & ALLERGY
  • Facility Address: 256 N 2ND E
    REXBURG, ID
    ZIP 83440
  • Facility Phone: 208 656-9646
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: BARRY PETERSON
  • NPI Number: 1124462494
  • Taxonomy: 207YX0905X - Otolaryngology

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/2/2025
Certificate Expiration Date 3/1/2027
Facility Type Physician Office
Lab Director BARRY PETERSON

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