13D2134030 CLIA NUMBER - CLIFFORD FAMILY MEDICINE

Laboratory Demographics

  • CLIA Code: 13D2134030
  • Facility Name: CLIFFORD FAMILY MEDICINE
  • Facility Address: 4742 YELLOWSTONE AVE
    CHUBBUCK, ID
    ZIP 83202
  • Facility Phone: 208 251-0316
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KYLE CLIFFORD
  • NPI Number: 1881190650
  • Taxonomy: 207Q00000X - Family Medicine

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 13D2134030
LAB Type Physician Office
Facility Name CLIFFORD FAMILY MEDICINE
Street 4742 YELLOWSTONE AVE
City CHUBBUCK
State ID
ZIP 83202
Phone 208 251-0316
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/14/2024
Certificate Expiration Date 5/13/2026
Facility Type Physician Office
Lab Director KYLE CLIFFORD

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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