13D2110315 CLIA NUMBER - INNER HEALTH MD

Laboratory Demographics

  • CLIA Code: 13D2110315
  • Facility Name: INNER HEALTH MD
  • Facility Address: 180 W 1ST ST STE 206
    KETCHUM, ID
    ZIP 83340
  • Facility Phone: 208 578-4550
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: THOMAS E. ARCHIE
  • NPI Number: 1265895775
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 13D2110315
LAB Type Physician Office
Facility Name INNER HEALTH MD
Street 180 W 1ST ST STE 206
City KETCHUM
State ID
ZIP 83340
Phone 208 578-4550
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 4/15/2024
Certificate Expiration Date 4/14/2026
Facility Type Physician Office
Lab Director THOMAS E. ARCHIE

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