Southern Idaho Regional Laboratory LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

13D0646359 Issued in ID

Legal business name

SOUTHERN IDAHO REGIONAL LABORATORY LLC

Practice address

335 SW 13TH St
Ontario, OR 97914-4547

Phone

(541) 889-4513

NPI assigned

Feb 4, 2015

Organization subpart

Yes

Parent organization

SOUTHERN IDAHO REGIONAL LABORATORY LLCAs reported in NPPES

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

Authorized official

Name

Clarrissa Willett

Title

Cfo

Phone

(509) 755-8903

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Treasure Valley Laboratory Doing business as

Part of

Southern Idaho Reg Lab

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

{
    "created_epoch": "1423008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423008000000",
    "number": "1508256041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2693",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992202693",
            "telephone_number": "509-755-8700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "335 SW 13TH ST",
            "city": "ONTARIO",
            "state": "OR",
            "postal_code": "979144547",
            "telephone_number": "541-889-4513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN IDAHO REGIONAL LABORATORY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHERN IDAHO REGIONAL LABORATORY LLC",
        "enumeration_date": "2015-02-04",
        "last_updated": "2015-02-04",
        "status": "A",
        "authorized_official_last_name": "WILLETT",
        "authorized_official_first_name": "CLARRISSA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "509-755-8903"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "ID",
            "license": "13D0646359",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805437200",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Treasure Valley Laboratory",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Peter W. Smith, MS
• Snake River Pediatrics
• Snake River Radiology PC
• Brandon Alden Snow, DMD
• Maricela Sotelo
• Lacie Catherine Spagnola, OD
• Donna Spencer
• Threasa Spencer, QMHA
• Frank J Spokas Jr., MD
• Sports & Ortho Rehab

• Clinical Medical Laboratory in Ontario, OR
• Providers in Ontario, OR by specialty
• Clinical Medical Laboratory in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2015; 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.