24D0403946 CLIA NUMBER - ESSENTIA HEALTH LAKESIDE CLINIC

Laboratory Demographics

  • CLIA Code: 24D0403946
  • Facility Name: ESSENTIA HEALTH LAKESIDE CLINIC
  • Facility Address: 4621 EAST SUPERIOR STREET
    DULUTH, MN
    ZIP 55804
  • Facility Phone: 218 576-0448
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SANDRA MATTSON
  • NPI Number: 1245278936
  • Taxonomy: 261QM1300X - Clinic/Center

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 24D0403946
LAB Type Physician Office
Facility Name ESSENTIA HEALTH LAKESIDE CLINIC
Street 4621 EAST SUPERIOR STREET
City DULUTH
State MN
ZIP 55804
Phone 218 576-0448
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/1/2025
Certificate Expiration Date 9/30/2027
Facility Type Physician Office
Lab Director SANDRA MATTSON

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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