13D2234793 CLIA NUMBER - ASC NORTHWEST

Laboratory Demographics

  • CLIA Code: 13D2234793
  • Facility Name: ASC NORTHWEST
  • Facility Address: 850 W IRONWOOD DR STE 300
    COEUR D'ALENE, ID
    ZIP 83814
  • Facility Phone: 208 667-1376
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: DOUGLAS BLATY
  • NPI Number: 1033712781
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 13D2234793
LAB Type Ambulatory Surgery Center
Facility Name ASC NORTHWEST
Street 850 W IRONWOOD DR STE 300
City COEUR D'ALENE
State ID
ZIP 83814
Phone 208 667-1376
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/2/2025
Certificate Expiration Date 9/1/2027
Facility Type Ambulatory Surgery Center
Lab Director DOUGLAS BLATY

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