Idaho Department of Health and Welfare, Bureau of Laboratories

NPI #1023148038 in Boise, Idaho

Provider Information

NPI Number: 1023148038
Entity Type: Organization
Organization Name: Idaho Department of Health and Welfare, Bureau of Laboratories
Primary Specialty: Clinical Medical Laboratory
Enumeration Date: Mar 7, 2007
Last Updated: Oct 24, 2019

Practice Location

Address: 2220 OLD PENITENTIARY RD
City: Boise
State: Idaho
ZIP Code: 83712-8299
Phone: (208) 334-2235

Authorized Official

Name: ELKE SHAW-TULLOCH, MHS
Title: DIVISION ADMINISTRATOR & STATE HEAL
Phone: (208) 334-6996

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinical Medical Laboratory	291U00000X	Primary

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