13D1086286 CLIA NUMBER - PEND OREILLE SURGERY CENTER

Laboratory Demographics

  • CLIA Code: 13D1086286
  • Facility Name: PEND OREILLE SURGERY CENTER
  • Facility Address: 30544 HWY 200 #201
    PONDERAY, ID
    ZIP 83852
  • Facility Phone: 208 265-8194
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: CHARLES CRANE
  • NPI Number: 1821276353
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 13D1086286
LAB Type Ambulatory Surgery Center
Facility Name PEND OREILLE SURGERY CENTER
Street 30544 HWY 200 #201
City PONDERAY
State ID
ZIP 83852
Phone 208 265-8194
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/9/2024
Certificate Expiration Date 7/8/2026
Facility Type Ambulatory Surgery Center
Lab Director CHARLES CRANE

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