13D2068325 CLIA NUMBER - ST LUKE'S INTERNAL MEDICINE

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Laboratory Demographics

CLIA Number: 13D2068325

Facility Name: ST LUKE'S INTERNAL MEDICINE

Facility Address:
520 S EAGLE RD STE 3102
MERIDIAN, ID
ZIP 83642
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Facility Phone Number: 208 706-5100

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1316980345

Taxonomy: 261QM2500X - Clinic/Center
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).

CLIA Record

Field Name	Field Value
CLIA Number	13D2068325
LAB Type	Physician Office
Facility Name	ST LUKE'S INTERNAL MEDICINE
Street	520 S EAGLE RD STE 3102
City	MERIDIAN
State	ID
ZIP	83642
Phone	208 706-5100
CertificateType	4
CertificateEffectiveDate	11/3/2023
CertificateExpirationDate	11/2/2025
FacilityType	Waiver

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