13D2112574 CLIA NUMBER - BINGHAM HEALTHCARE SPECIALTY CLINIC-17TH ST

Laboratory Demographics

  • CLIA Code: 13D2112574
  • Facility Name: BINGHAM HEALTHCARE SPECIALTY CLINIC-17TH ST
  • Facility Address: 1740 E 17TH STREET
    IDAHO FALLS, ID
    ZIP 83404
  • Facility Phone: 208 785-3861
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MICHAEL HARRIS
  • NPI Number: 1922512722
  • Taxonomy: 208600000X - Surgery

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CLIA Record

Field Name Field Value
CLIA Number 13D2112574
LAB Type Physician Office
Facility Name BINGHAM HEALTHCARE SPECIALTY CLINIC-17TH ST
Street 1740 E 17TH STREET
City IDAHO FALLS
State ID
ZIP 83404
Phone 208 785-3861
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/3/2024
Certificate Expiration Date 5/2/2026
Facility Type Physician Office
Lab Director MICHAEL HARRIS

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