13D2102630 CLIA NUMBER - LATAH COMMUNITY HEALTH

Laboratory Demographics

CLIA Number: 13D2102630

Facility Name: LATAH COMMUNITY HEALTH

Facility Address:
803 S MAIN ST STE 120
MOSCOW, ID
ZIP 83843
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Facility Phone Number: 509 444-8888

Facility Type: Federally Qualified Health Center

Certificate Type: Microscopy

NPI Number: 1285077230

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	13D2102630
LAB Type	Federally Qualified Health Center
Facility Name	LATAH COMMUNITY HEALTH
Street	803 S MAIN ST STE 120
City	MOSCOW
State	ID
ZIP	83843
Phone	509 444-8888
CertificateType	3
CertificateEffectiveDate	9/25/2023
CertificateExpirationDate	9/24/2025
FacilityType	PPMP

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