24D0403761 CLIA NUMBER - FAIRVIEW MESABA CLINIC - HIBBING

Laboratory Demographics

  • CLIA Code: 24D0403761
  • Facility Name: FAIRVIEW MESABA CLINIC - HIBBING
  • Facility Address: 3605 MAYFAIR AVENUE
    HIBBING, MN
    ZIP 55746
  • Facility Phone: 218 362-6935
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: TRACY M. SEVERSON
  • NPI Number: 1023583929
  • Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies

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CLIA Record

Field Name Field Value
CLIA Number 24D0403761
LAB Type Physician Office
Facility Name FAIRVIEW MESABA CLINIC - HIBBING
Street 3605 MAYFAIR AVENUE
City HIBBING
State MN
ZIP 55746
Phone 218 362-6935
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/16/2023
Certificate Expiration Date 11/15/2025
Facility Type Physician Office
Lab Director TRACY M. SEVERSON

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