Organization
IDAHO STATE UNIVERSITY
Active
Organization
IDAHO STATE UNIVERSITY
Active
Parent organization
BENGAL LABORATORY
Organization subpart
Yes
Provider details
NPI number
Legal business name
BENGAL LABORATORY
Authorized official
JAMES A. FLETCHER (VICE PRESIDENT OF FINANCE & ADMIN.)
(208) 282-3540
Entity
Organization
Contact information
Practice address
970 S 5TH AVE, STOP 8288, POCATELLO, ID 83209-0001
(208) 282-4456
Mailing address
921 S 8TH AVE, STOP 8288, POCATELLO, ID 83209-0001
(208) 282-4456
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Enumeration date
09/30/2015
Last updated
09/30/2015
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