13D2115708 CLIA NUMBER - GEM STATE ENDOSCOPY PLLC

Laboratory Demographics

  • CLIA Code: 13D2115708
  • Facility Name: GEM STATE ENDOSCOPY PLLC
  • Facility Address: 3709 14TH STREET
    LEWISTON, ID
    ZIP 83501
  • Facility Phone: 208 298-2141
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: MANDOLYN KNIGHT
  • NPI Number: 1821459496
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 13D2115708
LAB Type Ambulatory Surgery Center
Facility Name GEM STATE ENDOSCOPY PLLC
Street 3709 14TH STREET
City LEWISTON
State ID
ZIP 83501
Phone 208 298-2141
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/12/2024
Certificate Expiration Date 7/11/2026
Facility Type Ambulatory Surgery Center
Lab Director MANDOLYN KNIGHT

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