24D2215793 CLIA NUMBER - SHAKOPEE CBOC

Laboratory Demographics

  • CLIA Code: 24D2215793
  • Facility Name: SHAKOPEE CBOC
  • Facility Address: 1555 LUISITANO ST
    SHAKOPEE, MN
    ZIP 55379
  • Facility Phone: 952 445-4070
  • Facility Type: Community Clinic
  • Facility Type: Accreditation
  • Lab Director: JUSTIN PELTOLA
  • NPI Number: 1073976601
  • Taxonomy: 302R00000X - Health Maintenance Organization

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CLIA Record

Field Name Field Value
CLIA Number 24D2215793
LAB Type Community Clinic
Facility Name SHAKOPEE CBOC
Street 1555 LUISITANO ST
City SHAKOPEE
State MN
ZIP 55379
Phone 952 445-4070
Certificate Type Certificate of Accreditation
Certificate Type Description This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.
Certificate Effective Date 3/8/2021
Certificate Expiration Date 5/22/2026
Facility Type Community Clinic
Lab Director JUSTIN PELTOLA

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