13D1105419 CLIA NUMBER - SOUTHERN IDAHO PAIN INSTITUTE PC

Laboratory Demographics

CLIA Number: 13D1105419

Facility Name: SOUTHERN IDAHO PAIN INSTITUTE PC

Facility Address:
120 ROSE ST N
TWIN FALLS, ID
ZIP 83301
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Facility Phone Number: 208 733-3181

Facility Type: Physician Office

Certificate Type: Certificate of Compliance

NPI Number: 1336240670

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	13D1105419
LAB Type	Physician Office
Facility Name	SOUTHERN IDAHO PAIN INSTITUTE PC
Street	120 ROSE ST N
City	TWIN FALLS
State	ID
ZIP	83301
Phone	208 733-3181
CertificateType	2
CertificateEffectiveDate	3/14/2024
CertificateExpirationDate	3/13/2026
FacilityType	Compliance

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