13D2120213 CLIA NUMBER - MOUNTAIN PINE DERMATOLOGY

Laboratory Demographics

  • CLIA Code: 13D2120213
  • Facility Name: MOUNTAIN PINE DERMATOLOGY
  • Facility Address: 4664 N PENNGROVE WAY STE 100
    MERIDIAN, ID
    ZIP 83646
  • Facility Phone: 208 898-7467
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: RICHARD S. THOMAS
  • NPI Number: 1659827665
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 13D2120213
LAB Type Physician Office
Facility Name MOUNTAIN PINE DERMATOLOGY
Street 4664 N PENNGROVE WAY STE 100
City MERIDIAN
State ID
ZIP 83646
Phone 208 898-7467
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 11/28/2024
Certificate Expiration Date 11/27/2026
Facility Type Physician Office
Lab Director RICHARD S. THOMAS

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