13D2118784 CLIA NUMBER - ST LUKE'S CHILDREN'S PEDIATRICS CALDWELL

Laboratory Demographics

CLIA Number: 13D2118784

Facility Name: ST LUKE'S CHILDREN'S PEDIATRICS CALDWELL

Facility Address:
1620 S KIMBALL AVE
CALDWELL, ID
ZIP 83605
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Facility Phone Number: 208 505-2950

Facility Type: Community Clinic

Certificate Type: Waiver

NPI Number: 1770873572

Taxonomy: 207RC0000X - Internal Medicine
An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms.

CLIA Record

Field Name	Field Value
CLIA Number	13D2118784
LAB Type	Community Clinic
Facility Name	ST LUKE'S CHILDREN'S PEDIATRICS CALDWELL
Street	1620 S KIMBALL AVE
City	CALDWELL
State	ID
ZIP	83605
Phone	208 505-2950
CertificateType	4
CertificateEffectiveDate	9/14/2022
CertificateExpirationDate	9/13/2024
FacilityType	Waiver

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