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13D2100443 CLIA NUMBER - SHOSHONE-BANNOCK COMMUNITY HEALTH CENTER

Laboratory Demographics

CLIA Number: 13D2100443

Facility Name: SHOSHONE-BANNOCK COMMUNITY HEALTH CENTER

Facility Address:
BLDG 70 NAVAJO DR
FORT HALL, ID
ZIP 83203
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Facility Phone Number: 208 478-3987

Facility Type: Federally Qualified Health Center

Certificate Type: Microscopy
NPI Number: 1225570716

Taxonomy: 332800000X - Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
An Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy means a pharmacy operated by the Indian Health Service, an Indian tribe or tribal organization, or an urban Indian organization, all of which are defined in Section 4 of the Indian Health Care Improvement Act, 25 U.S.C. 1603.

CLIA Record

Field Name Field Value
CLIA Number 13D2100443
LAB Type Federally Qualified Health Center
Facility Name SHOSHONE-BANNOCK COMMUNITY HEALTH CENTER
Street BLDG 70 NAVAJO DR
City FORT HALL
State ID
ZIP 83203
Phone 208 478-3987
CertificateType 3
CertificateEffectiveDate 6/19/2023
CertificateExpirationDate 6/18/2025
FacilityType PPMP

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