24D0402688 CLIA NUMBER - NORTHWEST FAMILY CLINICS

Laboratory Demographics

CLIA Code: 24D0402688
Facility Name: NORTHWEST FAMILY CLINICS
Facility Address: 5700 BOTTINEAU BLVD STE 100
CRYSTAL, MN
ZIP 55429
Facility Phone: 763 504-6542
Facility Type: Physician Office
Facility Type: Accreditation
Lab Director: JONATHAN TALLMAN
NPI Number: 1629198965
Taxonomy: 320800000X - Community Based Residential Treatment Facility, Mental Illness

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CLIA Record

Field Name	Field Value
CLIA Number	24D0402688
LAB Type	Physician Office
Facility Name	NORTHWEST FAMILY CLINICS
Street	5700 BOTTINEAU BLVD STE 100
City	CRYSTAL
State	MN
ZIP	55429
Phone	763 504-6542
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	JONATHAN TALLMAN

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