Provider Demographics
NPI:1245648260
Name:SOUTHERN IDAHO EXAMINERS
Entity type:Organization
Organization Name:SOUTHERN IDAHO EXAMINERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:EDINBOROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-733-2022
Mailing Address - Street 1:206 MARTIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-4591
Mailing Address - Country:US
Mailing Address - Phone:208-733-2022
Mailing Address - Fax:
Practice Address - Street 1:206 MARTIN ST STE B
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4591
Practice Address - Country:US
Practice Address - Phone:208-733-2022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory