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13D2173910 CLIA NUMBER - ST JOSEPH'S EAR NOSE THROAT & ALLERGY CLINIC

Laboratory Demographics

CLIA Number: 13D2173910

Facility Name: ST JOSEPH'S EAR NOSE THROAT & ALLERGY CLINIC

Facility Address:
2288 N MERRITT CREEK LOOP STE 100
COEUR D'ALENE, ID
ZIP 83814
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Facility Phone Number: 208 215-2284

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1952355539

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name Field Value
CLIA Number 13D2173910
LAB Type Physician Office
Facility Name ST JOSEPH'S EAR NOSE THROAT & ALLERGY CLINIC
Street 2288 N MERRITT CREEK LOOP STE 100
City COEUR D'ALENE
State ID
ZIP 83814
Phone 208 215-2284
CertificateType 4
CertificateEffectiveDate 10/22/2023
CertificateExpirationDate 10/21/2025
FacilityType Waiver

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