13D2004717 CLIA NUMBER - BLAINE COUNTY JAIL-MEDICAL

Laboratory Demographics

  • CLIA Code: 13D2004717
  • Facility Name: BLAINE COUNTY JAIL-MEDICAL
  • Facility Address: 1650 AVIATION DR
    HAILEY, ID
    ZIP 83333
  • Facility Phone: 208 788-5561
  • Facility Type: Prison
  • Facility Type: Waiver
  • Lab Director: SHERRY D. STOUTIN
  • NPI Number: 1205980950
  • Taxonomy: 251300000X - Local Education Agency (LEA)

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CLIA Record

Field Name Field Value
CLIA Number 13D2004717
LAB Type Prison
Facility Name BLAINE COUNTY JAIL-MEDICAL
Street 1650 AVIATION DR
City HAILEY
State ID
ZIP 83333
Phone 208 788-5561
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/29/2023
Certificate Expiration Date 10/28/2025
Facility Type Prison
Lab Director SHERRY D. STOUTIN

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