13D2134030 CLIA NUMBER - CLIFFORD AND CLARK FAMILY MEDICINE

Laboratory Demographics

CLIA Number: 13D2134030

Facility Name: CLIFFORD AND CLARK FAMILY MEDICINE

Facility Address:
4750 YELLOWSTONE AVE
CHUBBUCK, ID
ZIP 83202
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Facility Phone Number: 208 251-0316

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1881190650

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name	Field Value
CLIA Number	13D2134030
LAB Type	Physician Office
Facility Name	CLIFFORD AND CLARK FAMILY MEDICINE
Street	4750 YELLOWSTONE AVE
City	CHUBBUCK
State	ID
ZIP	83202
Phone	208 251-0316
CertificateType	3
CertificateEffectiveDate	6/14/2023
CertificateExpirationDate	6/13/2025
FacilityType	PPMP

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