24D0666567 CLIA NUMBER - PARK NICOLLET CLINIC - EAGAN

Laboratory Demographics

CLIA Number: 24D0666567

Facility Name: PARK NICOLLET CLINIC - EAGAN

Facility Address:
1885 PLAZA DRIVE
EAGAN, MN
ZIP 55122
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Facility Phone Number: 952 993-4060

Facility Type: Physician Office

Certificate Type: Accreditation

NPI Number: 1659450963

Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies
A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.

CLIA Record

Field Name	Field Value
CLIA Number	24D0666567
LAB Type	Physician Office
Facility Name	PARK NICOLLET CLINIC - EAGAN
Street	1885 PLAZA DRIVE
City	EAGAN
State	MN
ZIP	55122
Phone	952 993-4060
CertificateType	1
CertificateEffectiveDate	10/2/2022
CertificateExpirationDate	10/1/2024
FacilityType	Accreditation

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