13D2054986 CLIA NUMBER - ST LUKE'S ELKS CHILDREN'S PAVILION

Laboratory Demographics

  • CLIA Code: 13D2054986
  • Facility Name: ST LUKE'S ELKS CHILDREN'S PAVILION
  • Facility Address: 305 E JEFFERSON ST
    BOISE, ID
    ZIP 83712
  • Facility Phone: 208 381-7336
  • Facility Type: Community Clinic
  • Facility Type: Microscopy
  • Lab Director: HENRY THOMPSON
  • NPI Number: 1780117259
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 13D2054986
LAB Type Community Clinic
Facility Name ST LUKE'S ELKS CHILDREN'S PAVILION
Street 305 E JEFFERSON ST
City BOISE
State ID
ZIP 83712
Phone 208 381-7336
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 3/4/2025
Certificate Expiration Date 3/3/2027
Facility Type Community Clinic
Lab Director HENRY THOMPSON

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