13D2013216 CLIA NUMBER - ST LUKE'S MOUNTAIN STATES UROLOGY - EAGLE

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Laboratory Demographics

CLIA Number: 13D2013216

Facility Name: ST LUKE'S MOUNTAIN STATES UROLOGY - EAGLE

Facility Address:
3101 E STATE ST #2107
EAGLE, ID
ZIP 83616
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Facility Phone Number: 208 706-5800

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1780793596

Taxonomy: 208800000X - Urology
A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures.

CLIA Record

Field Name	Field Value
CLIA Number	13D2013216
LAB Type	Physician Office
Facility Name	ST LUKE'S MOUNTAIN STATES UROLOGY - EAGLE
Street	3101 E STATE ST #2107
City	EAGLE
State	ID
ZIP	83616
Phone	208 706-5800
CertificateType	3
CertificateEffectiveDate	9/16/2022
CertificateExpirationDate	9/15/2024
FacilityType	PPMP

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