13D2292235 CLIA NUMBER - TELLICA IMAGING

Laboratory Demographics

  • CLIA Code: 13D2292235
  • Facility Name: TELLICA IMAGING
  • Facility Address: 8505 OVERLAND RD
    BOISE, ID
    ZIP 83709
  • Facility Phone: 208 258-3000
  • Facility Type: Other - IMAGING CENTER
  • Facility Type: Waiver
  • Lab Director: R DOUGLAS GREALLY
  • NPI Number: 1760197198
  • Taxonomy: 261QR0200X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 13D2292235
LAB Type Other - IMAGING CENTER
Facility Name TELLICA IMAGING
Street 8505 OVERLAND RD
City BOISE
State ID
ZIP 83709
Phone 208 258-3000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/23/2025
Certificate Expiration Date 10/22/2027
Facility Type Other - IMAGING CENTER
Lab Director R DOUGLAS GREALLY

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