Organization
BEAR TOOTH LABORATORY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON DOUGLAS COOMBS MPC (OWNER)
(801) 350-1716
Entity
Organization
Contact information
Practice address
1125 E PINE AVE, STE B, MERIDIAN, ID 83642-5955
(801) 350-1716
Mailing address
1125 E PINE AVE, STE B, MERIDIAN, ID 83642-5955
(801) 350-1716
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
P1825
ID
Other
Enumeration date
10/08/2015
Last updated
10/08/2015
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