13D1089437 CLIA NUMBER - PREMIER SURGICAL CENTER

Laboratory Demographics

  • CLIA Code: 13D1089437
  • Facility Name: PREMIER SURGICAL CENTER
  • Facility Address: 5680 W GAGE ST
    BOISE, ID
    ZIP 83706
  • Facility Phone: 208 377-3937
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: JACOB A. MONG
  • NPI Number: 1275516718
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 13D1089437
LAB Type Ambulatory Surgery Center
Facility Name PREMIER SURGICAL CENTER
Street 5680 W GAGE ST
City BOISE
State ID
ZIP 83706
Phone 208 377-3937
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/17/2024
Certificate Expiration Date 9/16/2026
Facility Type Ambulatory Surgery Center
Lab Director JACOB A. MONG

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