50D2197237 CLIA NUMBER - EXCELSIOR FAMILY MEDICINE INDIAN TRAIL

Laboratory Demographics

  • CLIA Code: 50D2197237
  • Facility Name: EXCELSIOR FAMILY MEDICINE INDIAN TRAIL
  • Facility Address: 3754 W INDIAN TRAIL RD
    SPOKANE, WA
    ZIP 99208
  • Facility Phone: 509 467-1100
  • Facility Type: Other - CLINIC
  • Facility Type: Waiver
  • Lab Director: DANIEL REPSOLD
  • NPI Number: 1326672692
  • Taxonomy: 251S00000X - Community/Behavioral Health

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CLIA Record

Field Name Field Value
CLIA Number 50D2197237
LAB Type Other - CLINIC
Facility Name EXCELSIOR FAMILY MEDICINE INDIAN TRAIL
Street 3754 W INDIAN TRAIL RD
City SPOKANE
State WA
ZIP 99208
Phone 509 467-1100
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/22/2020
Certificate Expiration Date 4/4/2028
Facility Type Other - CLINIC
Lab Director DANIEL REPSOLD

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