24D0405271 CLIA NUMBER - SANFORD HEALTH - MOUNTAIN LAKE CLINIC

Laboratory Demographics

  • CLIA Code: 24D0405271
  • Facility Name: SANFORD HEALTH - MOUNTAIN LAKE CLINIC
  • Facility Address: 308 NORTH 8TH STREET
    MOUNTAIN LAKE, MN
    ZIP 56159
  • Facility Phone: 507 427-3332
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: BRETT VAN KLEY
  • NPI Number: 1568469039
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 24D0405271
LAB Type Rural Health Clinic
Facility Name SANFORD HEALTH - MOUNTAIN LAKE CLINIC
Street 308 NORTH 8TH STREET
City MOUNTAIN LAKE
State MN
ZIP 56159
Phone 507 427-3332
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/10/2024
Certificate Expiration Date 12/9/2026
Facility Type Rural Health Clinic
Lab Director BRETT VAN KLEY

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