13D2058336 CLIA NUMBER - SUMMIT PSYCHIATRY & FAMILY WELLNESS

Laboratory Demographics

  • CLIA Code: 13D2058336
  • Facility Name: SUMMIT PSYCHIATRY & FAMILY WELLNESS
  • Facility Address: 217 W GEORGIA AVE #120
    NAMPA, ID
    ZIP 83686
  • Facility Phone: 208 498-1760
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DEO M. PEPPERSACK
  • NPI Number: 1437504909
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 13D2058336
LAB Type Physician Office
Facility Name SUMMIT PSYCHIATRY & FAMILY WELLNESS
Street 217 W GEORGIA AVE #120
City NAMPA
State ID
ZIP 83686
Phone 208 498-1760
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/6/2025
Certificate Expiration Date 5/5/2027
Facility Type Physician Office
Lab Director DEO M. PEPPERSACK

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