13D1068152 CLIA NUMBER - MAGIC VALLEY FAMILY PRACTICE

Laboratory Demographics

CLIA Number: 13D1068152

Facility Name: MAGIC VALLEY FAMILY PRACTICE

Facility Address:
2167 VILLAGE PARK AVE STE 300
TWIN FALLS, ID
ZIP 83301
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Facility Phone Number: 208 733-5117

Facility Type: Practitioner Other

Certificate Type: Microscopy

NPI Number: 1528251519

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	13D1068152
LAB Type	Practitioner Other
Facility Name	MAGIC VALLEY FAMILY PRACTICE
Street	2167 VILLAGE PARK AVE STE 300
City	TWIN FALLS
State	ID
ZIP	83301
Phone	208 733-5117
CertificateType	3
CertificateEffectiveDate	5/3/2023
CertificateExpirationDate	5/2/2025
FacilityType	PPMP

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