13D2295432 CLIA NUMBER - INNOVATIVE FAMILY MEDICINE OF IDAHO PLLC

Laboratory Demographics

  • CLIA Code: 13D2295432
  • Facility Name: INNOVATIVE FAMILY MEDICINE OF IDAHO PLLC
  • Facility Address: 512 POLE LINE RD STE 2
    TWIN FALLS, ID
    ZIP 83301
  • Facility Phone: 208 254-0047
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: AARON BROWN
  • NPI Number: 1962015776
  • Taxonomy: 2085R0202X - Radiology

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CLIA Record

Field Name Field Value
CLIA Number 13D2295432
LAB Type Physician Office
Facility Name INNOVATIVE FAMILY MEDICINE OF IDAHO PLLC
Street 512 POLE LINE RD STE 2
City TWIN FALLS
State ID
ZIP 83301
Phone 208 254-0047
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/12/2023
Certificate Expiration Date 12/11/2025
Facility Type Physician Office
Lab Director AARON BROWN

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