13D2060604 CLIA NUMBER - CLEARWATER GASTROENTEROLOGY

Laboratory Demographics

  • CLIA Code: 13D2060604
  • Facility Name: CLEARWATER GASTROENTEROLOGY
  • Facility Address: 2517 17TH ST STE B
    LEWISTON, ID
    ZIP 83501
  • Facility Phone: (208) 743-4373
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CARL R. DETTWILER
  • NPI Number: 1518205715
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 13D2060604
LAB Type Physician Office
Facility Name CLEARWATER GASTROENTEROLOGY
Street 2517 17TH ST STE B
City LEWISTON
State ID
ZIP 83501
Phone 2087434373
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/13/2025
Certificate Expiration Date 6/12/2027
Facility Type Physician Office
Lab Director CARL R. DETTWILER

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This page was last updated on: 5/18/2026