13D2198784 CLIA NUMBER - MOUNTAIN RIVER IV HEALTH & WELLNESS

Laboratory Demographics

  • CLIA Code: 13D2198784
  • Facility Name: MOUNTAIN RIVER IV HEALTH & WELLNESS
  • Facility Address: 1306 E 17TH ST
    IDAHO FALLS, ID
    ZIP 83404
  • Facility Phone: 208 528-6749
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: BRIAN R. JOHNSON APRN-FNP
  • NPI Number: 1699141150
  • Taxonomy: 208VP0000X - Pain Medicine

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CLIA Record

Field Name Field Value
CLIA Number 13D2198784
LAB Type Practitioner Other
Facility Name MOUNTAIN RIVER IV HEALTH & WELLNESS
Street 1306 E 17TH ST
City IDAHO FALLS
State ID
ZIP 83404
Phone 208 528-6749
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/4/2024
Certificate Expiration Date 11/3/2026
Facility Type Practitioner Other
Lab Director BRIAN R. JOHNSON APRN-FNP

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This page was last updated on: 9/29/2025