13D2042294 CLIA NUMBER - KOOTENAI CLINIC DIABETES & ENDOCRINOLOGY

Laboratory Demographics

  • CLIA Code: 13D2042294
  • Facility Name: KOOTENAI CLINIC DIABETES & ENDOCRINOLOGY
  • Facility Address: 1919 LINCOLN WAY #211
    COEUR D'ALENE, ID
    ZIP 83814
  • Facility Phone: 208 625-5500
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MARIA RODEBAUGH
  • NPI Number: 1386856284
  • Taxonomy: 152W00000X - Optometrist

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CLIA Record

Field Name Field Value
CLIA Number 13D2042294
LAB Type Physician Office
Facility Name KOOTENAI CLINIC DIABETES & ENDOCRINOLOGY
Street 1919 LINCOLN WAY #211
City COEUR D'ALENE
State ID
ZIP 83814
Phone 208 625-5500
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/8/2024
Certificate Expiration Date 6/7/2026
Facility Type Physician Office
Lab Director MARIA RODEBAUGH

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