13D2074775 CLIA NUMBER - FALL RIVER FAMILY MEDICINE

Laboratory Demographics

  • CLIA Code: 13D2074775
  • Facility Name: FALL RIVER FAMILY MEDICINE
  • Facility Address: 21 WINN DR
    REXBURG, ID
    ZIP 83440
  • Facility Phone: 208 881-5222
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: AUSTIN C. GILLETTE
  • NPI Number: 1457698987
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 13D2074775
LAB Type Physician Office
Facility Name FALL RIVER FAMILY MEDICINE
Street 21 WINN DR
City REXBURG
State ID
ZIP 83440
Phone 208 881-5222
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 3/18/2025
Certificate Expiration Date 3/17/2027
Facility Type Physician Office
Lab Director AUSTIN C. GILLETTE

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