13D2013562 CLIA NUMBER - BORRON FAMILY MEDICINE LLC

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Laboratory Demographics

CLIA Number: 13D2013562

Facility Name: BORRON FAMILY MEDICINE LLC

Facility Address:
790 W USTICK RD #110
MERIDIAN, ID
ZIP 83646
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Facility Phone Number: 208 639-3990

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1033424429

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	13D2013562
LAB Type	Practitioner Other
Facility Name	BORRON FAMILY MEDICINE LLC
Street	790 W USTICK RD #110
City	MERIDIAN
State	ID
ZIP	83646
Phone	208 639-3990
CertificateType	4
CertificateEffectiveDate	9/22/2022
CertificateExpirationDate	9/21/2024
FacilityType	Waiver

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