24D2174558 CLIA NUMBER - MINOR MEDICAL SQUAD

Laboratory Demographics

CLIA Number: 24D2174558

Facility Name: MINOR MEDICAL SQUAD

Facility Address:
826 TRENTON LN N
PLYMOUTH, MN
ZIP 55441
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Facility Phone Number: 612 504-6160

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1821646985

Taxonomy: -

CLIA Record

Field Name	Field Value
CLIA Number	24D2174558
LAB Type	Practitioner Other
Facility Name	MINOR MEDICAL SQUAD
Street	826 TRENTON LN N
City	PLYMOUTH
State	MN
ZIP	55441
Phone	612 504-6160
CertificateType	4
CertificateEffectiveDate	11/5/2023
CertificateExpirationDate	11/4/2025
FacilityType	Waiver

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