24D1095370 CLIA NUMBER - PHYSICIANS GROUP LLC SPRUCE TREE CENTRE

Laboratory Demographics

  • CLIA Code: 24D1095370
  • Facility Name: PHYSICIANS GROUP LLC SPRUCE TREE CENTRE
  • Facility Address: 1600 UNIVERSITY AVE WEST SUITE 306
    SAINT PAUL, MN
    ZIP 55104
  • Facility Phone: 651 209-6060
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: GREGORY BRONNER
  • NPI Number: 1396929519
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 24D1095370
LAB Type Physician Office
Facility Name PHYSICIANS GROUP LLC SPRUCE TREE CENTRE
Street 1600 UNIVERSITY AVE WEST SUITE 306
City SAINT PAUL
State MN
ZIP 55104
Phone 651 209-6060
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/6/2025
Certificate Expiration Date 2/5/2027
Facility Type Physician Office
Lab Director GREGORY BRONNER

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