24D2147126 CLIA NUMBER - BLAINE ASC LLC

Laboratory Demographics

  • CLIA Code: 24D2147126
  • Facility Name: BLAINE ASC LLC
  • Facility Address: 11225 ULYSSES STREET NORTHEAST
    BLAINE, MN
    ZIP 55434
  • Facility Phone: 763 302-2200
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: PETER D. HOLMBERG
  • NPI Number: 1922526961
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 24D2147126
LAB Type Ambulatory Surgery Center
Facility Name BLAINE ASC LLC
Street 11225 ULYSSES STREET NORTHEAST
City BLAINE
State MN
ZIP 55434
Phone 763 302-2200
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/13/2024
Certificate Expiration Date 4/12/2026
Facility Type Ambulatory Surgery Center
Lab Director PETER D. HOLMBERG

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