13D2322170 CLIA NUMBER - ADD CLINIC - AMITY

Laboratory Demographics

  • CLIA Code: 13D2322170
  • Facility Name: ADD CLINIC - AMITY
  • Facility Address: 1221 W AMITY RD
    BOISE, ID
    ZIP 83709
  • Facility Phone: 208 370-5888
  • Facility Type: Independent
  • Facility Type: Waiver
  • Lab Director: KYLE RONNAU
  • NPI Number: 1326877762
  • Taxonomy: 363LP0808X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 13D2322170
LAB Type Independent
Facility Name ADD CLINIC - AMITY
Street 1221 W AMITY RD
City BOISE
State ID
ZIP 83709
Phone 208 370-5888
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/16/2025
Certificate Expiration Date 4/15/2027
Facility Type Independent
Lab Director KYLE RONNAU

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