24D1025084 CLIA NUMBER - MENDAKOTA PEDIATRICS, LTD

Laboratory Demographics

  • CLIA Code: 24D1025084
  • Facility Name: MENDAKOTA PEDIATRICS, LTD
  • Facility Address: 1880 LIVINGSTON AVE STE 102
    WEST SAINT PAUL, MN
    ZIP 55118
  • Facility Phone: 651 552-7999
  • Facility Type: Physician Office
  • Facility Type: Accreditation
  • Lab Director: JENNIFER GOBEL
  • NPI Number: 1497739320
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 24D1025084
LAB Type Physician Office
Facility Name MENDAKOTA PEDIATRICS, LTD
Street 1880 LIVINGSTON AVE STE 102
City WEST SAINT PAUL
State MN
ZIP 55118
Phone 651 552-7999
Certificate Type Certificate of Accreditation
Certificate Type Description This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.
Certificate Effective Date 8/25/2025
Certificate Expiration Date 8/24/2027
Facility Type Physician Office
Lab Director JENNIFER GOBEL

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