13D0879418 CLIA NUMBER - MOSCOW PULLMAN OB/GYN

Laboratory Demographics

  • CLIA Code: 13D0879418
  • Facility Name: MOSCOW PULLMAN OB/GYN
  • Facility Address: 623 S MAIN ST #5
    MOSCOW, ID
    ZIP 83843
  • Facility Phone: 208 883-0813
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: CHARLES RICHARDS
  • NPI Number: 1386709624
  • Taxonomy: 207VC0200X - Obstetrics & Gynecology

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CLIA Record

Field Name Field Value
CLIA Number 13D0879418
LAB Type Physician Office
Facility Name MOSCOW PULLMAN OB/GYN
Street 623 S MAIN ST #5
City MOSCOW
State ID
ZIP 83843
Phone 208 883-0813
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 3/29/2024
Certificate Expiration Date 3/28/2026
Facility Type Physician Office
Lab Director CHARLES RICHARDS

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