13D0521095 CLIA NUMBER - TRI-STATE CLEARWATER MEDICAL CLINIC

Laboratory Demographics

  • CLIA Code: 13D0521095
  • Facility Name: TRI-STATE CLEARWATER MEDICAL CLINIC
  • Facility Address: 1522 17TH ST
    LEWISTON, ID
    ZIP 83501
  • Facility Phone: (208) 743-8416
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JILL BALL

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CLIA Record

Field Name Field Value
CLIA Number 13D0521095
LAB Type Physician Office
Facility Name TRI-STATE CLEARWATER MEDICAL CLINIC
Street 1522 17TH ST
City LEWISTON
State ID
ZIP 83501
Phone 2087438416
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/1/2025
Certificate Expiration Date 3/31/2027
Facility Type Physician Office
Lab Director JILL BALL

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This page was last updated on: 5/18/2026