13D1034518 CLIA NUMBER - NORTH IDAHO DIRECT PRIMARY CARE

Laboratory Demographics

CLIA Number: 13D1034518

Facility Name: NORTH IDAHO DIRECT PRIMARY CARE

Facility Address:
8880 N HESS ST #1
HAYDEN, ID
ZIP 83835
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Facility Phone Number: 208 772-5204

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1720523855

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	13D1034518
LAB Type	Physician Office
Facility Name	NORTH IDAHO DIRECT PRIMARY CARE
Street	8880 N HESS ST #1
City	HAYDEN
State	ID
ZIP	83835
Phone	208 772-5204
CertificateType	4
CertificateEffectiveDate	6/23/2022
CertificateExpirationDate	6/22/2024
FacilityType	Waiver

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