13D2126611 CLIA NUMBER - UPPER VALLEY SURGERY CENTER PLLC

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Field Name	Field Value
CLIA Number	13D2126611
LAB Type	Ambulatory Surgery Center
Facility Name	UPPER VALLEY SURGERY CENTER PLLC
Street	256 N 2ND E #1
City	REXBURG
State	ID
ZIP	83440
Phone	208 659-9646
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	3/1/2025
Certificate Expiration Date	2/28/2027
Facility Type	Ambulatory Surgery Center
Lab Director	JAY MCMASTERS

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