13D0996477 CLIA NUMBER - ISSC FRUITLAND

Laboratory Demographics

  • CLIA Code: 13D0996477
  • Facility Name: ISSC FRUITLAND
  • Facility Address: 975 NW 16TH ST
    FRUITLAND, ID
    ZIP 83619
  • Facility Phone: 208 452-7450
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: JARED SCOTT
  • NPI Number: 1902843485
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 13D0996477
LAB Type Physician Office
Facility Name ISSC FRUITLAND
Street 975 NW 16TH ST
City FRUITLAND
State ID
ZIP 83619
Phone 208 452-7450
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 10/18/2025
Certificate Expiration Date 10/17/2027
Facility Type Physician Office
Lab Director JARED SCOTT

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