13D2172471 CLIA NUMBER - SOUTHERN IDAHO FAMILY MEDICINE

Laboratory Demographics

CLIA Number: 13D2172471

Facility Name: SOUTHERN IDAHO FAMILY MEDICINE

Facility Address:
5524 PINLAND AVE
MERIDIAN, ID
ZIP 83642
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Facility Phone Number: (208) 985-3864

Facility Type: OTHER

Certificate Type: Waiver

NPI Number: 1043868995

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	13D2172471
LAB Type	OTHER
Facility Name	SOUTHERN IDAHO FAMILY MEDICINE
Street	5524 PINLAND AVE
City	MERIDIAN
State	ID
ZIP	83642
Phone	(208) 985-3864

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This page was last updated on: 5/11/2023