13D2247964 CLIA NUMBER - NORTHWEST FAMILY MEDICINE AND AXIS SPINE

Laboratory Demographics

  • CLIA Code: 13D2247964
  • Facility Name: NORTHWEST FAMILY MEDICINE AND AXIS SPINE
  • Facility Address: 7600 N MINERAL DR STE 450
    COEUR D'ALENE, ID
    ZIP 83815
  • Facility Phone: 208 262-2213
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JILLIAN MORTON
  • NPI Number: 1972660769
  • Taxonomy: 1223E0200X - Dentist

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CLIA Record

Field Name Field Value
CLIA Number 13D2247964
LAB Type Physician Office
Facility Name NORTHWEST FAMILY MEDICINE AND AXIS SPINE
Street 7600 N MINERAL DR STE 450
City COEUR D'ALENE
State ID
ZIP 83815
Phone 208 262-2213
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/11/2024
Certificate Expiration Date 1/10/2026
Facility Type Physician Office
Lab Director JILLIAN MORTON

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