13D2072959 CLIA NUMBER - LEWIS CLARK KIDNEY & HYPERTENSION CLINIC

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Laboratory Demographics

CLIA Number: 13D2072959

Facility Name: LEWIS CLARK KIDNEY & HYPERTENSION CLINIC

Facility Address:
2124 12TH AVE
LEWISTON, ID
ZIP 83501
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Facility Phone Number: 208 743-9986

Facility Type: Practitioner Other

Certificate Type: Microscopy

NPI Number: 1437573995

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	13D2072959
LAB Type	Practitioner Other
Facility Name	LEWIS CLARK KIDNEY & HYPERTENSION CLINIC
Street	2124 12TH AVE
City	LEWISTON
State	ID
ZIP	83501
Phone	208 743-9986
CertificateType	3
CertificateEffectiveDate	2/10/2024
CertificateExpirationDate	2/9/2026
FacilityType	PPMP

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This page was last updated on: 4/23/2024