24D0401213 CLIA NUMBER - PEDIATRIC SERVICES, PA

Laboratory Demographics

  • CLIA Code: 24D0401213
  • Facility Name: PEDIATRIC SERVICES, PA
  • Facility Address: 4700 PARK GLEN ROAD
    SAINT LOUIS PARK, MN
    ZIP 55416
  • Facility Phone: 952 922-4200
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: KELLY J. ISHIZUKA
  • NPI Number: 1962553917
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 24D0401213
LAB Type Physician Office
Facility Name PEDIATRIC SERVICES, PA
Street 4700 PARK GLEN ROAD
City SAINT LOUIS PARK
State MN
ZIP 55416
Phone 952 922-4200
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 6/20/2024
Certificate Expiration Date 6/19/2026
Facility Type Physician Office
Lab Director KELLY J. ISHIZUKA

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