13D0520769 CLIA NUMBER - FAMILY HEALTH SERVICES SHOSHONE

Laboratory Demographics

  • CLIA Code: 13D0520769
  • Facility Name: FAMILY HEALTH SERVICES SHOSHONE
  • Facility Address: 651 S BEVERLY ST
    SHOSHONE, ID
    ZIP 83352
  • Facility Phone: 208 886-2224
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Waiver
  • Lab Director: BASIL ANDERSON
  • NPI Number: 1972673218
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 13D0520769
LAB Type Federally Qualified Health Center
Facility Name FAMILY HEALTH SERVICES SHOSHONE
Street 651 S BEVERLY ST
City SHOSHONE
State ID
ZIP 83352
Phone 208 886-2224
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/1/2024
Certificate Expiration Date 7/31/2026
Facility Type Federally Qualified Health Center
Lab Director BASIL ANDERSON

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This page was last updated on: 9/29/2025