13D2053554 CLIA NUMBER - SKYLINE SURGERY CENTER

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Laboratory Demographics

CLIA Number: 13D2053554

Facility Name: SKYLINE SURGERY CENTER

Facility Address:
285 VISTA DRIVE
POCATELLO, ID
ZIP 83201
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Facility Phone Number: 208 478-1704

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1851552483

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	13D2053554
LAB Type	Ambulatory Surgery Center
Facility Name	SKYLINE SURGERY CENTER
Street	285 VISTA DRIVE
City	POCATELLO
State	ID
ZIP	83201
Phone	208 478-1704
CertificateType	4
CertificateEffectiveDate	2/4/2023
CertificateExpirationDate	2/3/2025
FacilityType	Waiver

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