13D0521684 CLIA NUMBER - ADA DERMATOLOGY CLINIC

Laboratory Demographics

  • CLIA Code: 13D0521684
  • Facility Name: ADA DERMATOLOGY CLINIC
  • Facility Address: 6454 W EMERALD ST
    BOISE, ID
    ZIP 83704
  • Facility Phone: 208 377-0820
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: RICHARD D. BLICKENSTAFF
  • NPI Number: 1952483299
  • Taxonomy: 207NS0135X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 13D0521684
LAB Type Physician Office
Facility Name ADA DERMATOLOGY CLINIC
Street 6454 W EMERALD ST
City BOISE
State ID
ZIP 83704
Phone 208 377-0820
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 12/11/2023
Certificate Expiration Date 12/10/2025
Facility Type Physician Office
Lab Director RICHARD D. BLICKENSTAFF

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