13D2215325 CLIA NUMBER - EAST MEETS WEST MEDICAL CLINIC

Laboratory Demographics

CLIA Number: 13D2215325

Facility Name: EAST MEETS WEST MEDICAL CLINIC

Facility Address:
353 W IOWA ST
NAMPA, ID
ZIP 83686
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Facility Phone Number: 480 430-3530

Facility Type: Ancillary Testing Site in Health Care Center

Certificate Type: Waiver

NPI Number: 1982299103

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	13D2215325
LAB Type	Ancillary Testing Site in Health Care Center
Facility Name	EAST MEETS WEST MEDICAL CLINIC
Street	353 W IOWA ST
City	NAMPA
State	ID
ZIP	83686
Phone	480 430-3530
CertificateType	4
CertificateEffectiveDate	3/2/2023
CertificateExpirationDate	3/1/2025
FacilityType	Waiver

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