13D0723819 CLIA NUMBER - NORTH IDAHO DIALYSIS

Laboratory Demographics

CLIA Number: 13D0723819

Facility Name: NORTH IDAHO DIALYSIS

Facility Address:
2100 IRONWOOD CT #A
COEUR D'ALENE, ID
ZIP 83814
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Facility Phone Number: 208 664-3064

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1912019720

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	13D0723819
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	NORTH IDAHO DIALYSIS
Street	2100 IRONWOOD CT #A
City	COEUR D'ALENE
State	ID
ZIP	83814
Phone	208 664-3064
CertificateType	4
CertificateEffectiveDate	3/7/2023
CertificateExpirationDate	3/6/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024