13D2188597 CLIA NUMBER - BONNER GENERAL FAMILY AND INTERNAL MEDICINE

Laboratory Demographics

  • CLIA Code: 13D2188597
  • Facility Name: BONNER GENERAL FAMILY AND INTERNAL MEDICINE
  • Facility Address: 423 N 3RD AVENUE STE 210
    SANDPOINT, ID
    ZIP 83864
  • Facility Phone: 208 265-2221
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: STACEY F. GOOD
  • NPI Number: 1033737887
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 13D2188597
LAB Type Physician Office
Facility Name BONNER GENERAL FAMILY AND INTERNAL MEDICINE
Street 423 N 3RD AVENUE STE 210
City SANDPOINT
State ID
ZIP 83864
Phone 208 265-2221
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 12/26/2024
Certificate Expiration Date 12/25/2026
Facility Type Physician Office
Lab Director STACEY F. GOOD

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