24D0726258 CLIA NUMBER - SANFORD HEALTH MAHNOMEN CLINIC

Laboratory Demographics

CLIA Number: 24D0726258

Facility Name: SANFORD HEALTH MAHNOMEN CLINIC

Facility Address:
410 WEST 4TH STREET
MAHNOMEN, MN
ZIP 56557
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Facility Phone Number: 218 935-2514

Facility Type: Community Clinic

Certificate Type: Waiver

NPI Number: 1831131234

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	24D0726258
LAB Type	Community Clinic
Facility Name	SANFORD HEALTH MAHNOMEN CLINIC
Street	410 WEST 4TH STREET
City	MAHNOMEN
State	MN
ZIP	56557
Phone	218 935-2514
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