13D2039395 CLIA NUMBER - ROCKY MOUNTAIN SURGERY CENTER

Laboratory Demographics

  • CLIA Code: 13D2039395
  • Facility Name: ROCKY MOUNTAIN SURGERY CENTER
  • Facility Address: 333 N 18TH AVE BLDG #C
    POCATELLO, ID
    ZIP 83201
  • Facility Phone: 208 239-3900
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: AMMON R. ASHBY
  • NPI Number: 1851808133
  • Taxonomy: 207P00000X - Emergency Medicine

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CLIA Record

Field Name Field Value
CLIA Number 13D2039395
LAB Type Ambulatory Surgery Center
Facility Name ROCKY MOUNTAIN SURGERY CENTER
Street 333 N 18TH AVE BLDG #C
City POCATELLO
State ID
ZIP 83201
Phone 208 239-3900
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/9/2024
Certificate Expiration Date 4/8/2026
Facility Type Ambulatory Surgery Center
Lab Director AMMON R. ASHBY

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