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13D2072091 CLIA NUMBER - BINGHAM HEALTHCARE SPECIALTY CLINIC-BANNOCK

Laboratory Demographics

CLIA Number: 13D2072091

Facility Name: BINGHAM HEALTHCARE SPECIALTY CLINIC-BANNOCK

Facility Address:
1151 HOSPITAL WAY STE D
POCATELLO, ID
ZIP 83201
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Facility Phone Number: 208 478-2449

Facility Type: Physician Office

Certificate Type: Microscopy
NPI Number: 1134621436

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name Field Value
CLIA Number 13D2072091
LAB Type Physician Office
Facility Name BINGHAM HEALTHCARE SPECIALTY CLINIC-BANNOCK
Street 1151 HOSPITAL WAY STE D
City POCATELLO
State ID
ZIP 83201
Phone 208 478-2449
CertificateType 3
CertificateEffectiveDate 12/1/2023
CertificateExpirationDate 11/30/2025
FacilityType PPMP

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