13D2295482 CLIA NUMBER - IDAHO ADVANCED MEDICAL CARE LLC

Laboratory Demographics

  • CLIA Code: 13D2295482
  • Facility Name: IDAHO ADVANCED MEDICAL CARE LLC
  • Facility Address: 13150 W PERSIMMON LN
    BOISE, ID
    ZIP 83713
  • Facility Phone: 208 510-9890
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: GINGER POWERS
  • NPI Number: 1487307468
  • Taxonomy: 363L00000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 13D2295482
LAB Type Physician Office
Facility Name IDAHO ADVANCED MEDICAL CARE LLC
Street 13150 W PERSIMMON LN
City BOISE
State ID
ZIP 83713
Phone 208 510-9890
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 GINGER POWERS

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This page was last updated on: 6/4/2025