13D1101987 CLIA NUMBER - MOSCOW DIALYSIS CENTER

Laboratory Demographics

  • CLIA Code: 13D1101987
  • Facility Name: MOSCOW DIALYSIS CENTER
  • Facility Address: 212 RODEO DR #110
    MOSCOW, ID
    ZIP 83843
  • Facility Phone: 208 882-5925
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: HENRY MROCH
  • NPI Number: 1225265606
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 13D1101987
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name MOSCOW DIALYSIS CENTER
Street 212 RODEO DR #110
City MOSCOW
State ID
ZIP 83843
Phone 208 882-5925
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/9/2025
Certificate Expiration Date 7/8/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director HENRY MROCH

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