13D2178527 CLIA NUMBER - MIDVALLEY HEALTHCARE

Laboratory Demographics

CLIA Number: 13D2178527

Facility Name: MIDVALLEY HEALTHCARE

Facility Address:
303 N ALLUMBAUGH ST #335
BOISE, ID
ZIP 83704
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Facility Phone Number: 208 888-5848

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1336553692

Taxonomy: 261QR0405X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	13D2178527
LAB Type	Physician Office
Facility Name	MIDVALLEY HEALTHCARE
Street	303 N ALLUMBAUGH ST #335
City	BOISE
State	ID
ZIP	83704
Phone	208 888-5848
CertificateType	4
CertificateEffectiveDate	2/4/2024
CertificateExpirationDate	2/3/2026
FacilityType	Waiver

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