47D2133967 CLIA NUMBER - IDEAL PRIMARY CARE

Laboratory Demographics

CLIA Number: 47D2133967

Facility Name: IDEAL PRIMARY CARE

Facility Address:
212 HOLIDAY DR, STE 4
WHITE RIVER JUNCTION, VT
ZIP 05001
Get Directions

Facility Phone Number: 802 698-8028

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1083135461

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	47D2133967
LAB Type	Practitioner Other
Facility Name	IDEAL PRIMARY CARE
Street	212 HOLIDAY DR, STE 4
City	WHITE RIVER JUNCTION
State	VT
ZIP	05001
Phone	802 698-8028
CertificateType	4
CertificateEffectiveDate	7/24/2023
CertificateExpirationDate	7/23/2025
FacilityType	Waiver

Download Record

Export to text format icon Download this CLIA NUMBER record in Text format: Export

Export to text format icon Download this CLIA NUMBER record in Excel (CSV) format: Export

Export to text format icon Download this CLIA NUMBER record in XML format: Export

This page was last updated on: 4/23/2024