24D0403966 CLIA NUMBER - LAKE SUPERIOR COMMUNITY HEALTH CENTER

Laboratory Demographics

CLIA Number: 24D0403966

Facility Name: LAKE SUPERIOR COMMUNITY HEALTH CENTER

Facility Address:
4325 GRAND AVENUE SUITE 1
DULUTH, MN
ZIP 55807
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Facility Phone Number: 218 722-1497

Facility Type: Federally Qualified Health Center

Certificate Type: Accreditation

NPI Number: 1568832277

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	24D0403966
LAB Type	Federally Qualified Health Center
Facility Name	LAKE SUPERIOR COMMUNITY HEALTH CENTER
Street	4325 GRAND AVENUE SUITE 1
City	DULUTH
State	MN
ZIP	55807
Phone	218 722-1497
CertificateType	1
CertificateEffectiveDate	1/16/2023
CertificateExpirationDate	1/15/2025
FacilityType	Accreditation

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