13D2108717 CLIA NUMBER - HERITAGE PHYSICIAN & RESOURCE GROUP

Laboratory Demographics

CLIA Number: 13D2108717

Facility Name: HERITAGE PHYSICIAN & RESOURCE GROUP

Facility Address:
1009 W QUINN RD
POCATELLO, ID
ZIP 83202
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Facility Phone Number: 208 238-0088

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1396074027

Taxonomy: 251E00000X - Home Health
A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety.

CLIA Record

Field Name Field Value
CLIA Number 13D2108717
LAB Type Physician Office
Facility Name HERITAGE PHYSICIAN & RESOURCE GROUP
Street 1009 W QUINN RD
City POCATELLO
State ID
ZIP 83202
Phone 208 238-0088
CertificateType 4
CertificateEffectiveDate 2/10/2024
CertificateExpirationDate 2/9/2026
FacilityType Waiver

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