13D2118549 CLIA NUMBER - FAMILY PRACTICE BY THE LAKE LLC

Laboratory Demographics

CLIA Number: 13D2118549

Facility Name: FAMILY PRACTICE BY THE LAKE LLC

Facility Address:
1875 N LAKEWOOD DR SUITE 205
COEUR D'ALENE, ID
ZIP 83814
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Facility Phone Number: 208 966-4087

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1295283810

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name	Field Value
CLIA Number	13D2118549
LAB Type	Physician Office
Facility Name	FAMILY PRACTICE BY THE LAKE LLC
Street	1875 N LAKEWOOD DR SUITE 205
City	COEUR D'ALENE
State	ID
ZIP	83814
Phone	208 966-4087
CertificateType	4
CertificateEffectiveDate	9/9/2022
CertificateExpirationDate	9/8/2024
FacilityType	Waiver

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