13D0522232 CLIA NUMBER - SHOSHONE MEDICAL CENTER

Laboratory Demographics

  • CLIA Code: 13D0522232
  • Facility Name: SHOSHONE MEDICAL CENTER
  • Facility Address: 25 JACOBS GULCH RD
    KELLOGG, ID
    ZIP 83837
  • Facility Phone: 208 784-1221
  • Facility Type: Hospital
  • Facility Type: Certificate of Compliance
  • Lab Director: DR. HEATHER GRIDLEY
  • NPI Number: 1487272399
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 13D0522232
LAB Type Hospital
Facility Name SHOSHONE MEDICAL CENTER
Street 25 JACOBS GULCH RD
City KELLOGG
State ID
ZIP 83837
Phone 208 784-1221
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 6/19/2025
Certificate Expiration Date 6/18/2027
Facility Type Hospital
Lab Director DR. HEATHER GRIDLEY

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