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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