Southern Idaho Regional Laboratory LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

SOUTHERN IDAHO REGIONAL LABORATORY LLC

Practice address

1055 N Curtis Rd
Boise, ID 83706-1309

Phone

(800) 574-8854

NPI assigned

Dec 20, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Kurt Rogers

Title

Cfo

Phone

(509) 755-8903

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Treasure Valley Laboratory Doing business as

Locations

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

{
    "created_epoch": "1135036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1262736000000",
    "number": "1730165838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "BOX 2693",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "99220",
            "telephone_number": "800-574-8854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1055 N CURTIS RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837061309",
            "telephone_number": "800-574-8854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN IDAHO REGIONAL LABORATORY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-20",
        "last_updated": "2010-01-06",
        "status": "A",
        "authorized_official_last_name": "ROGERS",
        "authorized_official_first_name": "KURT",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "509-755-8903",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "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"
        }
    ]
}

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• Jennifer A. Southard, M.D.
• Miriam Patricia Southern
• Southwest Dental Associates
• Southwest Idaho Advanced Care Hospital Inc -a Delaware Corp-
• Southwest Idaho Ear, Nose and Throat
• Southwest Idaho Surgery Center, Inc.

• Clinical Medical Laboratory in Boise, ID
• Providers in Boise, ID by specialty
• Clinical Medical Laboratory in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2010; 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.