24D2241174 CLIA NUMBER - KEY WELLNESS, PLLC

Laboratory Demographics

CLIA Number: 24D2241174

Facility Name: KEY WELLNESS, PLLC

Facility Address:
35752 ALLEN AVE
CROSS LAKE, MN
ZIP 56442
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Facility Phone Number: 218 692-5397

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1962175893

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	24D2241174
LAB Type	Practitioner Other
Facility Name	KEY WELLNESS, PLLC
Street	35752 ALLEN AVE
City	CROSS LAKE
State	MN
ZIP	56442
Phone	218 692-5397
CertificateType	4
CertificateEffectiveDate	10/26/2023
CertificateExpirationDate	10/25/2025
FacilityType	Waiver

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