24D0406580 CLIA NUMBER - SANFORD BEMIDJI CASS LAKE CLINIC

Laboratory Demographics

  • CLIA Code: 24D0406580
  • Facility Name: SANFORD BEMIDJI CASS LAKE CLINIC
  • Facility Address: 219 GRANT UTLEY AVENUE
    CASS LAKE, MN
    ZIP 56633
  • Facility Phone: 218 335-2559
  • Facility Type: Community Clinic
  • Facility Type: Microscopy
  • Lab Director: MARI K. OSBORNE
  • NPI Number: 1790710853
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 24D0406580
LAB Type Community Clinic
Facility Name SANFORD BEMIDJI CASS LAKE CLINIC
Street 219 GRANT UTLEY AVENUE
City CASS LAKE
State MN
ZIP 56633
Phone 218 335-2559
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 2/5/2025
Certificate Expiration Date 2/4/2027
Facility Type Community Clinic
Lab Director MARI K. OSBORNE

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