24D2262403 CLIA NUMBER - PIIC CLINICAL SERVICES PC - INFINITE CAMPUS

Laboratory Demographics

  • CLIA Code: 24D2262403
  • Facility Name: PIIC CLINICAL SERVICES PC - INFINITE CAMPUS
  • Facility Address: 4321 109TH AVE NE
    BLAINE, MN
    ZIP 55449
  • Facility Phone: 612 618-3647
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MIKE L. COWAN
  • NPI Number: 1053044149
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 24D2262403
LAB Type Physician Office
Facility Name PIIC CLINICAL SERVICES PC - INFINITE CAMPUS
Street 4321 109TH AVE NE
City BLAINE
State MN
ZIP 55449
Phone 612 618-3647
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/14/2024
Certificate Expiration Date 6/13/2026
Facility Type Physician Office
Lab Director MIKE L. COWAN

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