13D2057730 CLIA NUMBER - SOUTHFORK HEALTHCARE

Laboratory Demographics

  • CLIA Code: 13D2057730
  • Facility Name: SOUTHFORK HEALTHCARE
  • Facility Address: 3388 SWAN VALLEY HWY
    IRWIN, ID
    ZIP 83428
  • Facility Phone: 208 360-1997
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: WENDY SWOPE
  • NPI Number: 1134462856
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 13D2057730
LAB Type Practitioner Other
Facility Name SOUTHFORK HEALTHCARE
Street 3388 SWAN VALLEY HWY
City IRWIN
State ID
ZIP 83428
Phone 208 360-1997
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/23/2025
Certificate Expiration Date 4/22/2027
Facility Type Practitioner Other
Lab Director WENDY SWOPE

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