Organization
SOUTHERN IDAHO REGIONAL LABORATORY LLC
Active
Parent organization
SOUTHERN IDAHO REGIONAL LABORATORY LLC
Other names
Treasure Valley Laboratory
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTHERN IDAHO REGIONAL LABORATORY LLC
Authorized official
CLARRISSA WILLETT (CFO)
(509) 755-8903
Entity
Organization
Contact information
Practice address
335 SW 13TH ST, ONTARIO, OR 97914-4547
(541) 889-4513
Mailing address
PO BOX 2693, SPOKANE, WA 99220-2693
(509) 755-8700
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
13D0646359
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
805437200
—
ID
Enumeration date
02/04/2015
Last updated
02/04/2015
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