24D0691144 CLIA NUMBER - WATONWAN COUNTY

Laboratory Demographics

CLIA Number: 24D0691144

Facility Name: WATONWAN COUNTY

Facility Address:
715 2ND AVE SOUTH
SAINT JAMES, MN
ZIP 56081
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Facility Phone Number: 507 375-7863

Facility Type: Other - PUBLIC HEALTH CLINIC

Certificate Type: Waiver

NPI Number: 1972642122

Taxonomy: 251K00000X - Public Health or Welfare

CLIA Record

Field Name	Field Value
CLIA Number	24D0691144
LAB Type	Other - PUBLIC HEALTH CLINIC
Facility Name	WATONWAN COUNTY
Street	715 2ND AVE SOUTH
City	SAINT JAMES
State	MN
ZIP	56081
Phone	507 375-7863
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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