13D0856303 CLIA NUMBER - TABLE ROCK DIALYSIS CENTER

Laboratory Demographics

  • CLIA Code: 13D0856303
  • Facility Name: TABLE ROCK DIALYSIS CENTER
  • Facility Address: 5610 W GAGE ST #B
    BOISE, ID
    ZIP 83706
  • Facility Phone: 208 658-8111
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: NICHOLAS HUNT
  • NPI Number: 1871545418
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 13D0856303
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name TABLE ROCK DIALYSIS CENTER
Street 5610 W GAGE ST #B
City BOISE
State ID
ZIP 83706
Phone 208 658-8111
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director NICHOLAS HUNT

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