13D1091344 CLIA NUMBER - COEUR D'ALENE PEDIATRICS

Laboratory Demographics

  • CLIA Code: 13D1091344
  • Facility Name: COEUR D'ALENE PEDIATRICS
  • Facility Address: 9095 N HESS ST
    HAYDEN, ID
    ZIP 83835
  • Facility Phone: 208 772-8940
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. DUANE E. CRADDOCK
  • NPI Number: 1558931691
  • Taxonomy: 224P00000X - Prosthetist

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CLIA Record

Field Name Field Value
CLIA Number 13D1091344
LAB Type Physician Office
Facility Name COEUR D'ALENE PEDIATRICS
Street 9095 N HESS ST
City HAYDEN
State ID
ZIP 83835
Phone 208 772-8940
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/7/2025
Certificate Expiration Date 4/6/2027
Facility Type Physician Office
Lab Director DR. DUANE E. CRADDOCK

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