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24D2222681 CLIA NUMBER - CENTRAL MINNESOTA DERMATOLOGY PA

Laboratory Demographics

CLIA Number: 24D2222681

Facility Name: CENTRAL MINNESOTA DERMATOLOGY PA

Facility Address:
415 BARCLAY AVE
PINE RIVER, MN
ZIP 56474
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Facility Phone Number: 218 454-3376

Facility Type: Physician Office

Certificate Type: Microscopy
NPI Number: 1285220079

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 24D2222681
LAB Type Physician Office
Facility Name CENTRAL MINNESOTA DERMATOLOGY PA
Street 415 BARCLAY AVE
City PINE RIVER
State MN
ZIP 56474
Phone 218 454-3376
CertificateType 3
CertificateEffectiveDate 4/30/2023
CertificateExpirationDate 4/29/2025
FacilityType PPMP

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