13D2124532 CLIA NUMBER - MADISON AVENUE SURGERY CENTER LLC

Laboratory Demographics

  • CLIA Code: 13D2124532
  • Facility Name: MADISON AVENUE SURGERY CENTER LLC
  • Facility Address: 1855 MADISON AVE
    IDAHO FALLS, ID
    ZIP 83404
  • Facility Phone: 208 497-0535
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: BRETT MAXFIELD
  • NPI Number: 1396100491
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 13D2124532
LAB Type Ambulatory Surgery Center
Facility Name MADISON AVENUE SURGERY CENTER LLC
Street 1855 MADISON AVE
City IDAHO FALLS
State ID
ZIP 83404
Phone 208 497-0535
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/19/2025
Certificate Expiration Date 1/18/2027
Facility Type Ambulatory Surgery Center
Lab Director BRETT MAXFIELD

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