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13D2170375 CLIA NUMBER - KOOTENAI OCCUPATIONAL MEDICINE

Laboratory Demographics

CLIA Number: 13D2170375

Facility Name: KOOTENAI OCCUPATIONAL MEDICINE

Facility Address:
1112 W IRONWOOD DR
COEUR D'ALENE, ID
ZIP 83814
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Facility Phone Number: 208 292-2959

Facility Type: Other - OCCUPATIONAL MEDICINE

Certificate Type: Waiver
NPI Number: 1801147129

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name Field Value
CLIA Number 13D2170375
LAB Type Other - OCCUPATIONAL MEDICINE
Facility Name KOOTENAI OCCUPATIONAL MEDICINE
Street 1112 W IRONWOOD DR
City COEUR D'ALENE
State ID
ZIP 83814
Phone 208 292-2959
CertificateType 4
CertificateEffectiveDate 8/9/2023
CertificateExpirationDate 8/8/2025
FacilityType Waiver

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This page was last updated on: 4/23/2024