13D2193453 CLIA NUMBER - HENRY'S FORK SURGERY CENTER

Laboratory Demographics

  • CLIA Code: 13D2193453
  • Facility Name: HENRY'S FORK SURGERY CENTER
  • Facility Address: 23 SAWTELLE AVE STE 101
    REXBURG, ID
    ZIP 83440
  • Facility Phone: (208) 356-0700
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: JOSHUA R. FULLMER
  • NPI Number: 1235768490
  • Taxonomy: 261QA1903X - Clinic/Center

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 13D2193453
LAB Type Ambulatory Surgery Center
Facility Name HENRY'S FORK SURGERY CENTER
Street 23 SAWTELLE AVE STE 101
City REXBURG
State ID
ZIP 83440
Phone 2083560700
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/22/2024
Certificate Expiration Date 9/21/2026
Facility Type Ambulatory Surgery Center
Lab Director JOSHUA R. FULLMER

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

This page was last updated on: 5/18/2026