Organization
EASTERN IDAHO LABORATORY CONSULTANTS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CLARK DAINES M.D. (MANAGER)
(208) 529-6111
Entity
Organization
Contact information
Practice address
3100 CHANNING WAY, IDAHO FALLS, ID 83404-7533
(208) 259-6111
Mailing address
5700 SOUTHWYCK BLVD, TOLEDO, OH 43614-1509
(800) 288-8325
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Enumeration date
03/26/2024
Last updated
03/28/2024
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