13D2304900 CLIA NUMBER - NORTHWEST SURGERY CENTER

Laboratory Demographics

  • CLIA Code: 13D2304900
  • Facility Name: NORTHWEST SURGERY CENTER
  • Facility Address: 1624 E MULLAN AVE
    POST FALLS, ID
    ZIP 83854
  • Facility Phone: 208 770-2000
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Certificate of Compliance
  • Lab Director: JOHN C. STACKOW
  • NPI Number: 1285475418
  • Taxonomy: 367500000X - Nurse Anesthetist, Certified Registered

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CLIA Record

Field Name Field Value
CLIA Number 13D2304900
LAB Type Ambulatory Surgery Center
Facility Name NORTHWEST SURGERY CENTER
Street 1624 E MULLAN AVE
City POST FALLS
State ID
ZIP 83854
Phone 208 770-2000
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 10/23/2024
Certificate Expiration Date 10/22/2026
Facility Type Ambulatory Surgery Center
Lab Director JOHN C. STACKOW

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