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24D0405700 CLIA NUMBER - ST CLOUD EAR NOSE THROAT NECK & HEAD

Laboratory Demographics

CLIA Number: 24D0405700

Facility Name: ST CLOUD EAR NOSE THROAT NECK & HEAD

Facility Address:
1528 NORTHWAY DRIVE
SAINT CLOUD, MN
ZIP 56303
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Facility Phone Number: 320 252-0233

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1508882754

Taxonomy: 207Y00000X - Otolaryngology
An otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems and related structures of the head and neck. An otolaryngologist diagnoses and provides medical and/or surgical therapy or prevention of diseases, allergies, neoplasms, deformities, disorders and/or injuries of the ears, nose, sinuses, throat, respiratory and upper alimentary systems, face, jaws and the other head and neck systems. Head and neck oncology, facial plastic and reconstructive surgery and the treatment of disorders of hearing and voice are fundamental areas of expertise.

CLIA Record

Field Name Field Value
CLIA Number 24D0405700
LAB Type Physician Office
Facility Name ST CLOUD EAR NOSE THROAT NECK & HEAD
Street 1528 NORTHWAY DRIVE
City SAINT CLOUD
State MN
ZIP 56303
Phone 320 252-0233
CertificateType 4
CertificateEffectiveDate 2/1/2024
CertificateExpirationDate 1/31/2026
FacilityType Waiver

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