24D1042442 CLIA NUMBER - PERHAM HEALTH OTTERTAIL CLINIC

Laboratory Demographics

  • CLIA Code: 24D1042442
  • Facility Name: PERHAM HEALTH OTTERTAIL CLINIC
  • Facility Address: ATTN LABORATORY 105 OTTER DRIVE
    OTTERTAIL, MN
    ZIP 56571
  • Facility Phone: 218 367-6111
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: JERRY J. BALDWIN
  • NPI Number: 1710266986
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 24D1042442
LAB Type Rural Health Clinic
Facility Name PERHAM HEALTH OTTERTAIL CLINIC
Street ATTN LABORATORY 105 OTTER DRIVE
City OTTERTAIL
State MN
ZIP 56571
Phone 218 367-6111
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/1/2024
Certificate Expiration Date 7/31/2026
Facility Type Rural Health Clinic
Lab Director JERRY J. BALDWIN

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