13D2176348 CLIA NUMBER - TREASURE VALLEY METABOLIC MEDICINE LLC

Laboratory Demographics

CLIA Number: 13D2176348

Facility Name: TREASURE VALLEY METABOLIC MEDICINE LLC

Facility Address:
951 EAST PLAZA DR STE 110
EAGLE, ID
ZIP 83616
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Facility Phone Number: 208 830-6773

Facility Type: Independent

Certificate Type: Waiver

NPI Number: 1285271635

Taxonomy: 207RE0101X - Internal Medicine
An internist who concentrates on disorders of the internal (endocrine) glands such as the thyroid and adrenal glands. This specialist also deals with disorders such as diabetes, metabolic and nutritional disorders, obesity, pituitary diseases and menstrual and sexual problems.

CLIA Record

Field Name	Field Value
CLIA Number	13D2176348
LAB Type	Independent
Facility Name	TREASURE VALLEY METABOLIC MEDICINE LLC
Street	951 EAST PLAZA DR STE 110
City	EAGLE
State	ID
ZIP	83616
Phone	208 830-6773
CertificateType	4
CertificateEffectiveDate	12/12/2023
CertificateExpirationDate	12/11/2025
FacilityType	Waiver

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