Idaho Cytogenetics Diagnostic Lab

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

IDAHO CYTOGENETICS DIAGNOSTIC LAB

Practice address

2220 Old Penitentiary Rd
Ste 16
Boise, ID 83712-8249

Phone

(208) 376-8585

NPI assigned

Mar 21, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Sandi K Beach

Title

Billing Manager

Phone

(509) 755-8700

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1891811931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 78",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837070078",
            "telephone_number": "208-376-8585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2220 OLD PENITENTIARY RD",
            "address_2": "STE 16",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837128249",
            "telephone_number": "208-376-8585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO CYTOGENETICS DIAGNOSTIC LAB",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BEACH",
        "authorized_official_first_name": "SANDI",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "509-755-8700",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "ID",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• 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 Aug 22, 2020; 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.