24D2169532 CLIA NUMBER - M HEALTH FAIRVIEW CLINIC - MALL OF AMERICA

Laboratory Demographics

CLIA Number: 24D2169532

Facility Name: M HEALTH FAIRVIEW CLINIC - MALL OF AMERICA

Facility Address:
332 E BROADWAY
BLOOMINGTON, MN
ZIP 55425
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Facility Phone Number: 952 885-6072

Facility Type: Community Clinic

Certificate Type: Waiver

NPI Number: 1134773419

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	24D2169532
LAB Type	Community Clinic
Facility Name	M HEALTH FAIRVIEW CLINIC - MALL OF AMERICA
Street	332 E BROADWAY
City	BLOOMINGTON
State	MN
ZIP	55425
Phone	952 885-6072
CertificateType	4
CertificateEffectiveDate	1/17/2024
CertificateExpirationDate	1/16/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024