13D2298714 CLIA NUMBER - MYFAMILYDOC

Laboratory Demographics

  • CLIA Code: 13D2298714
  • Facility Name: MYFAMILYDOC
  • Facility Address: 1000 N CURTIS RD STE 105
    BOISE, ID
    ZIP 83706
  • Facility Phone: 650 284-6595
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: DIMITRI SHCHADENKO
  • NPI Number: 1346001377
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 13D2298714
LAB Type Practitioner Other
Facility Name MYFAMILYDOC
Street 1000 N CURTIS RD STE 105
City BOISE
State ID
ZIP 83706
Phone 650 284-6595
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/7/2024
Certificate Expiration Date 2/6/2026
Facility Type Practitioner Other
Lab Director DIMITRI SHCHADENKO

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