13D2122047 CLIA NUMBER - BOISE OSTEOPATHIC MEDICAL CLINIC

Laboratory Demographics

  • CLIA Code: 13D2122047
  • Facility Name: BOISE OSTEOPATHIC MEDICAL CLINIC
  • Facility Address: 7685 W EMERALD ST
    BOISE, ID
    ZIP 83704
  • Facility Phone: 208 376-2522
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RONALD S. HIGGINBOTHAM
  • NPI Number: 1306984943
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 13D2122047
LAB Type Physician Office
Facility Name BOISE OSTEOPATHIC MEDICAL CLINIC
Street 7685 W EMERALD ST
City BOISE
State ID
ZIP 83704
Phone 208 376-2522
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/18/2024
Certificate Expiration Date 11/17/2026
Facility Type Physician Office
Lab Director RONALD S. HIGGINBOTHAM

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