13D2015704 CLIA NUMBER - SPINE & PHYSICAL MEDICINE

Laboratory Demographics

  • CLIA Code: 13D2015704
  • Facility Name: SPINE & PHYSICAL MEDICINE
  • Facility Address: 2690 S EAGLE RD #150
    MERIDIAN, ID
    ZIP 83642
  • Facility Phone: 208 401-1000
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JAMES H. BATES
  • NPI Number: 1699973701
  • Taxonomy: 208100000X - Physical Medicine & Rehabilitation

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CLIA Record

Field Name Field Value
CLIA Number 13D2015704
LAB Type Physician Office
Facility Name SPINE & PHYSICAL MEDICINE
Street 2690 S EAGLE RD #150
City MERIDIAN
State ID
ZIP 83642
Phone 208 401-1000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/2/2024
Certificate Expiration Date 11/1/2026
Facility Type Physician Office
Lab Director JAMES H. BATES

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