13D2311885 CLIA NUMBER - SNAKE RIVER PEDIATRICS

Laboratory Demographics

  • CLIA Code: 13D2311885
  • Facility Name: SNAKE RIVER PEDIATRICS
  • Facility Address: 1100 NW 12TH ST BLDG B
    FRUITLAND, ID
    ZIP 83619
  • Facility Phone: 208 452-6556
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: MICHELLE F. DEVOE
  • NPI Number: 1871952267
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 13D2311885
LAB Type Rural Health Clinic
Facility Name SNAKE RIVER PEDIATRICS
Street 1100 NW 12TH ST BLDG B
City FRUITLAND
State ID
ZIP 83619
Phone 208 452-6556
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/1/2024
Certificate Expiration Date 9/30/2026
Facility Type Rural Health Clinic
Lab Director MICHELLE F. DEVOE

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