Organization
MEDICAL LAB SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WENDELL L WELLS MD (DIRECTOR)
(208) 678-8899
Entity
Organization
Contact information
Practice address
1501 HILAND AVE, SUITE J, BURLEY, ID 83318-2682
(208) 678-5215
(208) 678-1472
Mailing address
1501 HILAND AVE, SUITE J, BURLEY, ID 83318-2682
(208) 678-5215
(208) 678-1472
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
PO33
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
808196400
—
ID
Enumeration date
02/22/2007
Last updated
12/09/2008
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