24D0999563 CLIA NUMBER - ST PAUL FAMILY MEDICAL CENTER

Laboratory Demographics

CLIA Number: 24D0999563

Facility Name: ST PAUL FAMILY MEDICAL CENTER

Facility Address:
1239 PAYNE AVENUE
SAINT PAUL, MN
ZIP 55130
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Facility Phone Number: 651 209-8350

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1346302981

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	24D0999563
LAB Type	Physician Office
Facility Name	ST PAUL FAMILY MEDICAL CENTER
Street	1239 PAYNE AVENUE
City	SAINT PAUL
State	MN
ZIP	55130
Phone	651 209-8350
CertificateType	3
CertificateEffectiveDate	10/22/2023
CertificateExpirationDate	10/21/2025
FacilityType	PPMP

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