13D2244482 CLIA NUMBER - MAGIC VALLEY PAIN SPECIALISTS

Laboratory Demographics

  • CLIA Code: 13D2244482
  • Facility Name: MAGIC VALLEY PAIN SPECIALISTS
  • Facility Address: 1344 HILAND AVE SUITE A
    BURLEY, ID
    ZIP 83318
  • Facility Phone: 208 678-7246
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: TYLER C. ROE
  • NPI Number: 1902366834
  • Taxonomy: 261QM2500X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 13D2244482
LAB Type Physician Office
Facility Name MAGIC VALLEY PAIN SPECIALISTS
Street 1344 HILAND AVE SUITE A
City BURLEY
State ID
ZIP 83318
Phone 208 678-7246
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/2/2023
Certificate Expiration Date 12/1/2025
Facility Type Physician Office
Lab Director TYLER C. ROE

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