24D0402450 CLIA NUMBER - SOUTHWEST DERMATOLOGY SPECIALISTS, LTD

Laboratory Demographics

  • CLIA Code: 24D0402450
  • Facility Name: SOUTHWEST DERMATOLOGY SPECIALISTS, LTD
  • Facility Address: 6425 NICOLLET AVENUE
    RICHFIELD, MN
    ZIP 55423
  • Facility Phone: 612 869-2086
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DAVID W. GROTH
  • NPI Number: 1518331420
  • Taxonomy: 207NS0135X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 24D0402450
LAB Type Physician Office
Facility Name SOUTHWEST DERMATOLOGY SPECIALISTS, LTD
Street 6425 NICOLLET AVENUE
City RICHFIELD
State MN
ZIP 55423
Phone 612 869-2086
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 5/11/2024
Certificate Expiration Date 5/10/2026
Facility Type Physician Office
Lab Director DAVID W. GROTH

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