Organization
LOCAL LAB LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MORGANA SAMORA (MANAGER)
(208) 929-2234
Entity
Organization
Contact information
Practice address
8382 N WAYNE DR STE 201, HAYDEN, ID 83835-6028
(208) 714-0478
(855) 485-5234
Mailing address
8382 N WAYNE DR STE 201, HAYDEN, ID 83835-6028
(208) 714-0478
(855) 485-5234
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
13
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13D2141188
CLIA ID
ID
Enumeration date
03/19/2018
Last updated
09/12/2018
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