13D1077351 CLIA NUMBER - UPPER VALLEY COMMUNITY HEALTH SERVICES

Laboratory Demographics

CLIA Number: 13D1077351

Facility Name: UPPER VALLEY COMMUNITY HEALTH SERVICES

Facility Address:
335 EAST MAIN
SAINT ANTHONY, ID
ZIP 83445
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Facility Phone Number: 208 624-4100

Facility Type: Federally Qualified Health Center

Certificate Type: Certificate of Compliance

NPI Number: 1124403258

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	13D1077351
LAB Type	Federally Qualified Health Center
Facility Name	UPPER VALLEY COMMUNITY HEALTH SERVICES
Street	335 EAST MAIN
City	SAINT ANTHONY
State	ID
ZIP	83445
Phone	208 624-4100
CertificateType	2
CertificateEffectiveDate	8/13/2022
CertificateExpirationDate	8/12/2024
FacilityType	Compliance

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