13D1068152 CLIA NUMBER - MAGIC VALLEY FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 13D1068152
  • Facility Name: MAGIC VALLEY FAMILY PRACTICE
  • Facility Address: 2167 VILLAGE PARK AVE STE 300
    TWIN FALLS, ID
    ZIP 83301
  • Facility Phone: 208 733-5117
  • Facility Type: Practitioner Other
  • Facility Type: Microscopy
  • Lab Director: DREW SIMMONS
  • NPI Number: 1528251519
  • Taxonomy: 261QP2300X - Clinic/Center

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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
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 5/3/2025
Certificate Expiration Date 5/2/2027
Facility Type Practitioner Other
Lab Director DREW SIMMONS

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