24D0691417 CLIA NUMBER - ST PAUL DIALYSIS

Laboratory Demographics

  • CLIA Code: 24D0691417
  • Facility Name: ST PAUL DIALYSIS
  • Facility Address: 555 PARK STREET SUITE 180
    SAINT PAUL, MN
    ZIP 55103
  • Facility Phone: 651 291-8855
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: ALEC OTTEMAN
  • NPI Number: 1427012434
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 24D0691417
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name ST PAUL DIALYSIS
Street 555 PARK STREET SUITE 180
City SAINT PAUL
State MN
ZIP 55103
Phone 651 291-8855
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 ALEC OTTEMAN

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