13D2142603 CLIA NUMBER - SAINT ALPHONSUS ANTICOAGULATION CLINIC-EAGLE

Laboratory Demographics

  • CLIA Code: 13D2142603
  • Facility Name: SAINT ALPHONSUS ANTICOAGULATION CLINIC-EAGLE
  • Facility Address: 323 E RIVERSIDE DR STE 224
    EAGLE, ID
    ZIP 83616
  • Facility Phone: 208 367-8660
  • Facility Type: Ancillary Testing Site in Health Care Center
  • Facility Type: Waiver
  • Lab Director: ROBERT M. DREWETT PHARM D
  • NPI Number: 1548489735
  • Taxonomy: 225100000X - Physical Therapist

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CLIA Record

Field Name Field Value
CLIA Number 13D2142603
LAB Type Ancillary Testing Site in Health Care Center
Facility Name SAINT ALPHONSUS ANTICOAGULATION CLINIC-EAGLE
Street 323 E RIVERSIDE DR STE 224
City EAGLE
State ID
ZIP 83616
Phone 208 367-8660
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/9/2024
Certificate Expiration Date 9/8/2026
Facility Type Ancillary Testing Site in Health Care Center
Lab Director ROBERT M. DREWETT PHARM D

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