13D2171191 CLIA NUMBER - MORGAN FAMILY MEDICINE

Laboratory Demographics

CLIA Number: 13D2171191

Facility Name: MORGAN FAMILY MEDICINE

Facility Address:
1660 S WOODSAGE AVE BLDG A
MERIDIAN, ID
ZIP 83642
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Facility Phone Number: 208 906-1231

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1285293118

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	13D2171191
LAB Type	Practitioner Other
Facility Name	MORGAN FAMILY MEDICINE
Street	1660 S WOODSAGE AVE BLDG A
City	MERIDIAN
State	ID
ZIP	83642
Phone	208 906-1231
CertificateType	4
CertificateEffectiveDate	8/27/2023
CertificateExpirationDate	8/26/2025
FacilityType	Waiver

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