13D2310449 CLIA NUMBER - CATALYST MEDICAL GROUP INTERNAL MEDICINE MOSCOW

Laboratory Demographics

  • CLIA Code: 13D2310449
  • Facility Name: CATALYST MEDICAL GROUP INTERNAL MEDICINE MOSCOW
  • Facility Address: 1174 ALTURAS DR
    MOSCOW, ID
    ZIP 83843
  • Facility Phone: 208 746-1383
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KELLY M. BLEWETT
  • NPI Number: 1023545373
  • Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies

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CLIA Record

Field Name Field Value
CLIA Number 13D2310449
LAB Type Physician Office
Facility Name CATALYST MEDICAL GROUP INTERNAL MEDICINE MOSCOW
Street 1174 ALTURAS DR
City MOSCOW
State ID
ZIP 83843
Phone 208 746-1383
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/4/2024
Certificate Expiration Date 9/3/2026
Facility Type Physician Office
Lab Director KELLY M. BLEWETT

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