13D1085881 CLIA NUMBER - COMMUNITY CARE POCATELLO

Laboratory Demographics

  • CLIA Code: 13D1085881
  • Facility Name: COMMUNITY CARE POCATELLO
  • Facility Address: 1595 YELLOWSTONE AVE
    POCATELLO, ID
    ZIP 83201
  • Facility Phone: 208 233-0032
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: ETHAN L. MCCARTY
  • NPI Number: 1538517156
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 13D1085881
LAB Type Physician Office
Facility Name COMMUNITY CARE POCATELLO
Street 1595 YELLOWSTONE AVE
City POCATELLO
State ID
ZIP 83201
Phone 208 233-0032
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 10/23/2024
Certificate Expiration Date 10/22/2026
Facility Type Physician Office
Lab Director ETHAN L. MCCARTY

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