13D2189589 CLIA NUMBER - HEALTH WEST ISU COMMUNITY HEALTH CENTER

Laboratory Demographics

CLIA Number: 13D2189589

Facility Name: HEALTH WEST ISU COMMUNITY HEALTH CENTER

Facility Address:
465 MEMORIAL DR
POCATELLO, ID
ZIP 83201
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Facility Phone Number: 208 232-7862

Facility Type: Federally Qualified Health Center

Certificate Type: Microscopy

NPI Number: 1912261413

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	13D2189589
LAB Type	Federally Qualified Health Center
Facility Name	HEALTH WEST ISU COMMUNITY HEALTH CENTER
Street	465 MEMORIAL DR
City	POCATELLO
State	ID
ZIP	83201
Phone	208 232-7862
CertificateType	3
CertificateEffectiveDate	8/3/2022
CertificateExpirationDate	8/2/2024
FacilityType	PPMP

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