24D0691356 CLIA NUMBER - MISSISSIPPI GATEWAY DIALYSIS

Laboratory Demographics

  • CLIA Code: 24D0691356
  • Facility Name: MISSISSIPPI GATEWAY DIALYSIS
  • Facility Address: 3960 COON RAPIDS BLVD STE 309
    COON RAPIDS, MN
    ZIP 55433
  • Facility Phone: 763 421-8717
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: ALLYSON HART
  • NPI Number: 1861456337
  • Taxonomy: 261QE0700X - Clinic/Center

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 24D0691356
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name MISSISSIPPI GATEWAY DIALYSIS
Street 3960 COON RAPIDS BLVD STE 309
City COON RAPIDS
State MN
ZIP 55433
Phone 763 421-8717
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/20/2025
Certificate Expiration Date 7/19/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director ALLYSON HART

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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