24D2179696 CLIA NUMBER - ROOTS COMMUNITY BIRTH CENTER

Laboratory Demographics

  • CLIA Code: 24D2179696
  • Facility Name: ROOTS COMMUNITY BIRTH CENTER
  • Facility Address: 1901 44TH AVE N
    MINNEAPOLIS, MN
    ZIP 55412
  • Facility Phone: 612 338-2784
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: REBECCA R E POLSTON
  • NPI Number: 1407229750
  • Taxonomy: 261QB0400X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 24D2179696
LAB Type Physician Office
Facility Name ROOTS COMMUNITY BIRTH CENTER
Street 1901 44TH AVE N
City MINNEAPOLIS
State MN
ZIP 55412
Phone 612 338-2784
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/29/2024
Certificate Expiration Date 2/27/2026
Facility Type Physician Office
Lab Director REBECCA R E POLSTON

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