13D2075115 CLIA NUMBER - PRIMARY HEALTH MEDICAL GROUP - SOUTH MERIDIAN

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Laboratory Demographics

CLIA Number: 13D2075115

Facility Name: PRIMARY HEALTH MEDICAL GROUP - SOUTH MERIDIAN

Facility Address:
1623 S WELLS AVE
MERIDIAN, ID
ZIP 83642
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Facility Phone Number: 208 489-1450

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1033534276

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	13D2075115
LAB Type	Physician Office
Facility Name	PRIMARY HEALTH MEDICAL GROUP - SOUTH MERIDIAN
Street	1623 S WELLS AVE
City	MERIDIAN
State	ID
ZIP	83642
Phone	208 489-1450
CertificateType	3
CertificateEffectiveDate	3/24/2024
CertificateExpirationDate	3/23/2026
FacilityType	PPMP

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