NPI 1790841781

State of Idaho

Organisation Clinical Medical Laboratory Blackfoot, ID

Practice location

Address: 700 East Alice, Blackfoot, ID 83221
Phone: (208) 785-8429
Fax: (208) 785-8439
Mailing address: Box 400 700 East Alice, Blackfoot, ID 83221

Authorised official

Name: Ralph Duane Heckard
Title: Medical Director
Phone: (208) 785-8429

Registered specialties

Clinical Medical Laboratory Primary

Laboratories Taxonomy 291U00000X

Other Clinical Medical Laboratory providers in Idaho →

Registry record

NPI: 1790841781
Entity type: Organization
NPI issued: 28 Dec 2006
Record last updated: 22 Aug 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.