13D2170375 CLIA NUMBER - KOOTENAI OCCUPATIONAL MEDICINE

Laboratory Demographics

  • CLIA Code: 13D2170375
  • Facility Name: KOOTENAI OCCUPATIONAL MEDICINE
  • Facility Address: 2236 N MERRIT CREEK LOOP STE A
    COEUR D'ALENE, ID
    ZIP 83814
  • Facility Phone: (208) 625-3670
  • Facility Type: Hospital
  • Facility Type: Waiver
  • Lab Director: LARRY L. WELLENDORF
  • NPI Number: 1801147129
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 13D2170375
LAB Type Hospital
Facility Name KOOTENAI OCCUPATIONAL MEDICINE
Street 2236 N MERRIT CREEK LOOP STE A
City COEUR D'ALENE
State ID
ZIP 83814
Phone 2086253670
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/9/2025
Certificate Expiration Date 8/8/2027
Facility Type Hospital
Lab Director LARRY L. WELLENDORF

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