OrganizationActive
Eastern Idaho Laboratory Consultants LLC
NPI 1043060536 · Anatomic Pathology & Clinical Pathology Physician · Idaho Falls, ID
Provider details
- NPI number
- 1043060536
- Entity type
- Organization
- Primary specialty
- Anatomic Pathology & Clinical Pathology PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Clark Daines, Manager(208) 529-6111
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
3100 Channing Way
Idaho Falls, ID 83404-7533
Phone: (208) 259-6111
Approximate (ZIP-level) locationGet directions
Mailing address
5700 Southwyck Blvd
Toledo, OH 43614-1509
Registry dates
- Enumerated
- 2024-03-26
- Last updated
- 2024-03-28
- Certified
- 2024-03-28
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.