13D1091344 CLIA NUMBER - COEUR D'ALENE PEDIATRICS

Laboratory Demographics

CLIA Number: 13D1091344

Facility Name: COEUR D'ALENE PEDIATRICS

Facility Address:
9095 N HESS ST
HAYDEN, ID
ZIP 83835
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Facility Phone Number: 208 772-8940

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1558931691

Taxonomy: 224P00000X - Prosthetist
A health care professional who is specifically educated and trained to manage comprehensive prosthetic patient care for individuals who have sustained complete or partial limb loss or absence. Prosthetists assess specific patient needs, formulate an appropriate treatment plan, implement the treatment plan and provide follow-up care.

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
CertificateType	4
CertificateEffectiveDate	4/7/2023
CertificateExpirationDate	4/6/2025
FacilityType	Waiver

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