24D1080211 CLIA NUMBER - CENTRACARE - BIG LAKE

Laboratory Demographics

  • CLIA Code: 24D1080211
  • Facility Name: CENTRACARE - BIG LAKE
  • Facility Address: 16830 198TH AVE NW
    BIG LAKE, MN
    ZIP 55309
  • Facility Phone: 763 271-2819
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: BRIAN L. MACKENZII
  • NPI Number: 1013104348
  • Taxonomy: 261QM1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 24D1080211
LAB Type Physician Office
Facility Name CENTRACARE - BIG LAKE
Street 16830 198TH AVE NW
City BIG LAKE
State MN
ZIP 55309
Phone 763 271-2819
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/1/2025
Certificate Expiration Date 2/28/2027
Facility Type Physician Office
Lab Director BRIAN L. MACKENZII

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