13D1084701 CLIA NUMBER - PHYSICIANS & SURGEONS CLINIC OF POCATELLO

Laboratory Demographics

CLIA Number: 13D1084701

Facility Name: PHYSICIANS & SURGEONS CLINIC OF POCATELLO

Facility Address:
1151 HOSPITAL WAY #100
POCATELLO, ID
ZIP 83201
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Facility Phone Number: 208 239-8010

Facility Type: Rural Health Clinic

Certificate Type: Accreditation

NPI Number: 1114192986

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	13D1084701
LAB Type	Rural Health Clinic
Facility Name	PHYSICIANS & SURGEONS CLINIC OF POCATELLO
Street	1151 HOSPITAL WAY #100
City	POCATELLO
State	ID
ZIP	83201
Phone	208 239-8010
CertificateType	1
CertificateEffectiveDate	1/6/2023
CertificateExpirationDate	1/5/2025
FacilityType	Accreditation

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