13D2230426 CLIA NUMBER - FUNCTIONAL MEDICINE OF IDAHO

Laboratory Demographics

CLIA Number: 13D2230426

Facility Name: FUNCTIONAL MEDICINE OF IDAHO

Facility Address:
801 PINE ST STE 2
SANDPOINT, ID
ZIP 83864
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Facility Phone Number: 208 385-7711

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1740524701

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	13D2230426
LAB Type	Physician Office
Facility Name	FUNCTIONAL MEDICINE OF IDAHO
Street	801 PINE ST STE 2
City	SANDPOINT
State	ID
ZIP	83864
Phone	208 385-7711
CertificateType	4
CertificateEffectiveDate	7/23/2023
CertificateExpirationDate	7/22/2025
FacilityType	Waiver

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