13D2082228 CLIA NUMBER - ENNIS ENDOCRINOLOGY CLINIC

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Laboratory Demographics

CLIA Number: 13D2082228

Facility Name: ENNIS ENDOCRINOLOGY CLINIC

Facility Address:
2450 E GALA ST, STE 100
MERIDIAN, ID
ZIP 83642
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Facility Phone Number: 208 908-4541

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1902143134

Taxonomy: 207RE0101X - Internal Medicine
An internist who concentrates on disorders of the internal (endocrine) glands such as the thyroid and adrenal glands. This specialist also deals with disorders such as diabetes, metabolic and nutritional disorders, obesity, pituitary diseases and menstrual and sexual problems.

CLIA Record

Field Name	Field Value
CLIA Number	13D2082228
LAB Type	Physician Office
Facility Name	ENNIS ENDOCRINOLOGY CLINIC
Street	2450 E GALA ST, STE 100
City	MERIDIAN
State	ID
ZIP	83642
Phone	208 908-4541
CertificateType	4
CertificateEffectiveDate	8/11/2022
CertificateExpirationDate	8/10/2024
FacilityType	Waiver

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