Eastern Idaho Laboratory Consultants LLC

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

Legal business name

EASTERN IDAHO LABORATORY CONSULTANTS LLC

Practice address

3100 Channing Way
Idaho Falls, ID 83404-7533

Phone

(208) 259-6111

NPI assigned

Mar 26, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Clark Daines, M.D.

Title

Manager

Phone

(208) 529-6111

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1711411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711584000000",
    "number": "1043060536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5700 SOUTHWYCK BLVD",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436141509",
            "telephone_number": "800-288-8325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 CHANNING WAY",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047533",
            "telephone_number": "208-259-6111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN IDAHO LABORATORY CONSULTANTS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-26",
        "last_updated": "2024-03-28",
        "certification_date": "2024-03-28",
        "status": "A",
        "authorized_official_last_name": "DAINES",
        "authorized_official_first_name": "CLARK",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "208-529-6111",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eastern Idaho Health Services, Inc.
• Eastern Idaho Health Services, Inc.
• Eastern Idaho Health Services, Inc.
• Eastern Idaho Health Services, Inc.
• Eastern Idaho Intensivist LLC
• Eastern Idaho Medical Consultants
• Eastern Idaho Neurological Associates PA
• Eastern Idaho Public Health
• Eastern Idaho Public Health
• Eastern Idaho Public Health District

• Anatomic Pathology & Clinical Pathology Physician in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Anatomic Pathology & Clinical Pathology Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.