13D2302541 CLIA NUMBER - INTERMOUNTAIN MEDICAL IMAGING LLC

Laboratory Demographics

  • CLIA Code: 13D2302541
  • Facility Name: INTERMOUNTAIN MEDICAL IMAGING LLC
  • Facility Address: 875 S VANGUARD STE 100
    MERIDIAN, ID
    ZIP 83642
  • Facility Phone: 208 954-8100
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JOHN A. JACKSON
  • NPI Number: 1598524696
  • Taxonomy: 2085R0202X - Radiology

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CLIA Record

Field Name Field Value
CLIA Number 13D2302541
LAB Type Physician Office
Facility Name INTERMOUNTAIN MEDICAL IMAGING LLC
Street 875 S VANGUARD STE 100
City MERIDIAN
State ID
ZIP 83642
Phone 208 954-8100
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/11/2024
Certificate Expiration Date 4/10/2026
Facility Type Physician Office
Lab Director JOHN A. JACKSON

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