13D2192332 CLIA NUMBER - SNAKE RIVER COMMUNITY CLINIC

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Laboratory Demographics

CLIA Number: 13D2192332

Facility Name: SNAKE RIVER COMMUNITY CLINIC

Facility Address:
215 10TH ST
LEWISTON, ID
ZIP 83501
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Facility Phone Number: 208 743-5899

Facility Type: Community Clinic

Certificate Type: Microscopy

NPI Number: 1003440082

Taxonomy: 163WG0000X - Registered Nurse

CLIA Record

Field Name	Field Value
CLIA Number	13D2192332
LAB Type	Community Clinic
Facility Name	SNAKE RIVER COMMUNITY CLINIC
Street	215 10TH ST
City	LEWISTON
State	ID
ZIP	83501
Phone	208 743-5899
CertificateType	3
CertificateEffectiveDate	9/9/2022
CertificateExpirationDate	9/8/2024
FacilityType	PPMP

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