13D2169089 CLIA NUMBER - THRIVE PEDIATRICS

Laboratory Demographics

  • CLIA Code: 13D2169089
  • Facility Name: THRIVE PEDIATRICS
  • Facility Address: 4740 N PENNGROVE WAY #210
    MERIDIAN, ID
    ZIP 83646
  • Facility Phone: 208 514-0203
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: TAYLOR M. BRANDON
  • NPI Number: 1669934220
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 13D2169089
LAB Type Physician Office
Facility Name THRIVE PEDIATRICS
Street 4740 N PENNGROVE WAY #210
City MERIDIAN
State ID
ZIP 83646
Phone 208 514-0203
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/16/2025
Certificate Expiration Date 7/15/2027
Facility Type Physician Office
Lab Director TAYLOR M. BRANDON

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