13D2088880 CLIA NUMBER - BONNER PARTNERS IN CARE CLINIC

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Laboratory Demographics

CLIA Number: 13D2088880

Facility Name: BONNER PARTNERS IN CARE CLINIC

Facility Address:
2101 PINE STREET
SANDPOINT, ID
ZIP 83864
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Facility Phone Number: 208 255-9099

Facility Type: Community Clinic

Certificate Type: Waiver

NPI Number: 1063643690

Taxonomy: 261QC1500X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	13D2088880
LAB Type	Community Clinic
Facility Name	BONNER PARTNERS IN CARE CLINIC
Street	2101 PINE STREET
City	SANDPOINT
State	ID
ZIP	83864
Phone	208 255-9099
CertificateType	4
CertificateEffectiveDate	12/17/2022
CertificateExpirationDate	12/16/2024
FacilityType	Waiver

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