13D2051293 CLIA NUMBER - CASCADE FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 13D2051293
  • Facility Name: CASCADE FAMILY PRACTICE
  • Facility Address: 402 LAKE CASCADE PKWY
    CASCADE, ID
    ZIP 83611
  • Facility Phone: 208 382-3868
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: RONALD ELLSWORTH
  • NPI Number: 1184282170
  • Taxonomy: 122300000X - Dentist

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CLIA Record

Field Name Field Value
CLIA Number 13D2051293
LAB Type Rural Health Clinic
Facility Name CASCADE FAMILY PRACTICE
Street 402 LAKE CASCADE PKWY
City CASCADE
State ID
ZIP 83611
Phone 208 382-3868
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/17/2024
Certificate Expiration Date 12/16/2026
Facility Type Rural Health Clinic
Lab Director RONALD ELLSWORTH

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