24D0935436 CLIA NUMBER - STILLWATER MEDICAL GROUP GREELEY CLINIC

Laboratory Demographics

CLIA Number: 24D0935436

Facility Name: STILLWATER MEDICAL GROUP GREELEY CLINIC

Facility Address:
921 SOUTH GREELEY STREET
STILLWATER, MN
ZIP 55082
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Facility Phone Number: 651 275-3311

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1861742918

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name	Field Value
CLIA Number	24D0935436
LAB Type	Physician Office
Facility Name	STILLWATER MEDICAL GROUP GREELEY CLINIC
Street	921 SOUTH GREELEY STREET
City	STILLWATER
State	MN
ZIP	55082
Phone	651 275-3311
CertificateType	4
CertificateEffectiveDate	5/1/2022
CertificateExpirationDate	4/30/2024
FacilityType	Waiver

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