24D2086651 CLIA NUMBER - PHOENIX SERVICE CORPORATION

Laboratory Demographics

  • CLIA Code: 24D2086651
  • Facility Name: PHOENIX SERVICE CORPORATION
  • Facility Address: 222 PLATO BLVD EAST
    SAINT PAUL, MN
    ZIP 55107
  • Facility Phone: 651 227-7655
  • Facility Type: Other - 245D PROVIDER
  • Facility Type: Waiver
  • Lab Director: KIMBERLY E. HUMAN
  • NPI Number: 1881645067
  • Taxonomy: 251B00000X - Case Management

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CLIA Record

Field Name Field Value
CLIA Number 24D2086651
LAB Type Other - 245D PROVIDER
Facility Name PHOENIX SERVICE CORPORATION
Street 222 PLATO BLVD EAST
City SAINT PAUL
State MN
ZIP 55107
Phone 651 227-7655
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/7/2024
Certificate Expiration Date 11/6/2026
Facility Type Other - 245D PROVIDER
Lab Director KIMBERLY E. HUMAN

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