NPI age
13 years
Enumerated 2012-08-28
● Active Type 2 · Organization
Subpart
Ada West Dermatopathology, Llc
Ada West Dermatopathology, Llc is 1 of 75 clinical medical laboratory organizations in Idaho.
Primary specialty
Clinical Medical Laboratory
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Jones
Cfo
Last NPPES update
2022-11-10
Source: monthly bulk 2026-05
How this organization compares
Across 75 active clinical medical laboratory providers in Idaho.
NPI age
13 years
≈ at median (14 yr)
Practice locations
1
0 secondary on file
Subspecialties
0
NPI lifetime · 2012 → 2026
2012-08Enumerated in NPPES
2012
2026
Where they practice
Primary practice location
1618 Millenium Way, Ste 220
Meridian, ID 836426439
Mailing address
1618 Millenium Way, Ste 220
Meridian, ID 836426439
Authorized official
Colleen Jones
Cfo
📞 2088843376
Individual providers at this organization
4 individual providers on file at this primary practice address.
- Pamela Martin, PT ATC Physical Therapist NPI 1154380293
- Nicole Olsen Physical Therapist NPI 1740439470
- Lauren Scott, M.P.T. Physical Therapist NPI 1437266723
- Gregory Wells, M.D. Dermatology NPI 1871609370
Specialties
-
Clinical Medical Laboratory Primary(1) A clinical laboratory is a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human...
Identifiers
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 20002043 | MEDICARE PTAN |
Practice context
Multi-provider organization. 4 individual providers on file at this primary address.
Subpart of Ada West Dermatology, Pc.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
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