13D2050494 CLIA NUMBER - INTERMOUNTAIN MEDICAL IMAGING

Laboratory Demographics

  • CLIA Code: 13D2050494
  • Facility Name: INTERMOUNTAIN MEDICAL IMAGING
  • Facility Address: 323 E RIVERSIDE DR #108
    EAGLE, ID
    ZIP 83616
  • Facility Phone: (208) 367-3340
  • Facility Type: Other - RADIOLOGY CLINIC
  • Facility Type: Waiver
  • Lab Director: WILLIAM L. TAYLOR
  • NPI Number: 1326247511
  • Taxonomy: 2085R0202X - Radiology

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CLIA Record

Field Name Field Value
CLIA Number 13D2050494
LAB Type Other - RADIOLOGY CLINIC
Facility Name INTERMOUNTAIN MEDICAL IMAGING
Street 323 E RIVERSIDE DR #108
City EAGLE
State ID
ZIP 83616
Phone 2083673340
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/30/2024
Certificate Expiration Date 11/29/2026
Facility Type Other - RADIOLOGY CLINIC
Lab Director WILLIAM L. TAYLOR

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This page was last updated on: 5/18/2026