13D2276263 CLIA NUMBER - NORTHWEST FAMILY MEDICINE

Laboratory Demographics

  • CLIA Code: 13D2276263
  • Facility Name: NORTHWEST FAMILY MEDICINE
  • Facility Address: 7173 SUPER 1 LOOP STE B
    ATHOL, ID
    ZIP 83801
  • Facility Phone: 208 262-2300
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JOHN STACKOW
  • NPI Number: 1104824739
  • Taxonomy: 282N00000X - General Acute Care Hospital

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CLIA Record

Field Name Field Value
CLIA Number 13D2276263
LAB Type Physician Office
Facility Name NORTHWEST FAMILY MEDICINE
Street 7173 SUPER 1 LOOP STE B
City ATHOL
State ID
ZIP 83801
Phone 208 262-2300
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/6/2025
Certificate Expiration Date 2/5/2027
Facility Type Physician Office
Lab Director JOHN STACKOW

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