24D0400452 CLIA NUMBER - PARK NICOLLET CLINIC - PRAIRIE CENTER

Laboratory Demographics

  • CLIA Code: 24D0400452
  • Facility Name: PARK NICOLLET CLINIC - PRAIRIE CENTER
  • Facility Address: 8455 FLYING CLOUD DR
    EDEN PRAIRIE, MN
    ZIP 55344
  • Facility Phone: 952 993-7462
  • Facility Type: Physician Office
  • Facility Type: Accreditation
  • Lab Director: DR. STEVEN M. DEBOL
  • NPI Number: 1053623785
  • Taxonomy: 261QP2000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 24D0400452
LAB Type Physician Office
Facility Name PARK NICOLLET CLINIC - PRAIRIE CENTER
Street 8455 FLYING CLOUD DR
City EDEN PRAIRIE
State MN
ZIP 55344
Phone 952 993-7462
Certificate Type Certificate of Accreditation
Certificate Type Description This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.
Certificate Effective Date 12/23/2023
Certificate Expiration Date 12/22/2025
Facility Type Physician Office
Lab Director DR. STEVEN M. DEBOL

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