13D0885727 CLIA NUMBER - KOOTENAI TRIBAL HEALTH CLINIC

Laboratory Demographics

CLIA Number: 13D0885727

Facility Name: KOOTENAI TRIBAL HEALTH CLINIC

Facility Address:
1227 MISSION RD
BONNERS FERRY, ID
ZIP 83805
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Facility Phone Number: 208 267-5223

Facility Type: Community Clinic

Certificate Type: Microscopy

NPI Number: 1669594057

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	13D0885727
LAB Type	Community Clinic
Facility Name	KOOTENAI TRIBAL HEALTH CLINIC
Street	1227 MISSION RD
City	BONNERS FERRY
State	ID
ZIP	83805
Phone	208 267-5223
CertificateType	3
CertificateEffectiveDate	6/22/2023
CertificateExpirationDate	6/21/2025
FacilityType	PPMP

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