13D2215010 CLIA NUMBER - TEN MILE SURGERY CENTER

Laboratory Demographics

  • CLIA Code: 13D2215010
  • Facility Name: TEN MILE SURGERY CENTER
  • Facility Address: 875 S VANGUARD WAY STE 120
    MERIDIAN, ID
    ZIP 83642
  • Facility Phone: 208 960-0870
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: JENNIFER L. BLOXHAM
  • NPI Number: 1689260341
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 13D2215010
LAB Type Ambulatory Surgery Center
Facility Name TEN MILE SURGERY CENTER
Street 875 S VANGUARD WAY STE 120
City MERIDIAN
State ID
ZIP 83642
Phone 208 960-0870
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/26/2025
Certificate Expiration Date 2/25/2027
Facility Type Ambulatory Surgery Center
Lab Director JENNIFER L. BLOXHAM

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