24D0405701 CLIA NUMBER - CENTRACARE SOUTHWAY

Laboratory Demographics

CLIA Number: 24D0405701

Facility Name: CENTRACARE SOUTHWAY

Facility Address:
1301 33RD STREET SOUTH
SAINT CLOUD, MN
ZIP 56301
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Facility Phone Number: 320 251-8181

Facility Type: Physician Office

Certificate Type: Accreditation

NPI Number: 1669994315

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	24D0405701
LAB Type	Physician Office
Facility Name	CENTRACARE SOUTHWAY
Street	1301 33RD STREET SOUTH
City	SAINT CLOUD
State	MN
ZIP	56301
Phone	320 251-8181
CertificateType	1
CertificateEffectiveDate	12/23/2023
CertificateExpirationDate	12/22/2025
FacilityType	Accreditation

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