13D1083637 CLIA NUMBER - MOUNTAIN VIEW FAMILY MEDICINE

Laboratory Demographics

CLIA Number: 13D1083637

Facility Name: MOUNTAIN VIEW FAMILY MEDICINE

Facility Address:
1309 PONDEROSA DR #103
SANDPOINT, ID
ZIP 83864
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Facility Phone Number: 208 263-9545

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1962666578

Taxonomy: 261QH0100X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	13D1083637
LAB Type	Physician Office
Facility Name	MOUNTAIN VIEW FAMILY MEDICINE
Street	1309 PONDEROSA DR #103
City	SANDPOINT
State	ID
ZIP	83864
Phone	208 263-9545
CertificateType	4
CertificateEffectiveDate	5/7/2022
CertificateExpirationDate	5/6/2024
FacilityType	Waiver

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