13D2304135 CLIA NUMBER - INNOVATION MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 13D2304135
  • Facility Name: INNOVATION MEDICAL GROUP
  • Facility Address: 745 S PROGRESS AVE STE 150
    MERIDIAN, ID
    ZIP 83642
  • Facility Phone: 801 266-3113
  • Facility Type: Ancillary Testing Site in Health Care Center
  • Facility Type: Waiver
  • Lab Director: PAUL D. NIELSON
  • NPI Number: 1184329948
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 13D2304135
LAB Type Ancillary Testing Site in Health Care Center
Facility Name INNOVATION MEDICAL GROUP
Street 745 S PROGRESS AVE STE 150
City MERIDIAN
State ID
ZIP 83642
Phone 801 266-3113
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/8/2024
Certificate Expiration Date 5/7/2026
Facility Type Ancillary Testing Site in Health Care Center
Lab Director PAUL D. NIELSON

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