24D0402317 CLIA NUMBER - ANNEX TEEN MEDICAL CLNC

Laboratory Demographics

CLIA Number: 24D0402317

Facility Name: ANNEX TEEN MEDICAL CLNC

Facility Address:
5810 42ND AVENUE NORTH
ROBBINSDALE, MN
ZIP 55422
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Facility Phone Number: 612 533-1316

Facility Type: Community Clinic

Certificate Type: Microscopy

NPI Number: 1255462487

Taxonomy: 261QF0050X - Clinic/Center
An entity, facility, or distinct part of a facility, or mobile unit providing non-surgical, family planning/reproductive services including physical examination, laboratory services such as PAP or pregnancy tests; pregnancy, pregnancy prevention/contraceptive, and nutritional counseling, and contraceptives or prescriptions for contraceptives.

CLIA Record

Field Name	Field Value
CLIA Number	24D0402317
LAB Type	Community Clinic
Facility Name	ANNEX TEEN MEDICAL CLNC
Street	5810 42ND AVENUE NORTH
City	ROBBINSDALE
State	MN
ZIP	55422
Phone	612 533-1316
CertificateType	3
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	PPMP

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This page was last updated on: 4/23/2024