13D2162276 CLIA NUMBER - RIDGELINE MEDICAL

Laboratory Demographics

  • CLIA Code: 13D2162276
  • Facility Name: RIDGELINE MEDICAL
  • Facility Address: 2470 JAFER CT
    IDAHO FALLS, ID
    ZIP 83404
  • Facility Phone: (208) 715-9990
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DANNY SPENCER
  • NPI Number: 1386110963
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 13D2162276
LAB Type Physician Office
Facility Name RIDGELINE MEDICAL
Street 2470 JAFER CT
City IDAHO FALLS
State ID
ZIP 83404
Phone 2087159990
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/12/2026
Certificate Expiration Date 4/11/2028
Facility Type Physician Office
Lab Director DANNY SPENCER

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This page was last updated on: 5/18/2026