24D2264643 CLIA NUMBER - NORTHERN LAKES SURGERY CENTER LLC

Laboratory Demographics

  • CLIA Code: 24D2264643
  • Facility Name: NORTHERN LAKES SURGERY CENTER LLC
  • Facility Address: 4791 COUNTY ROAD 10
    MOOSE LAKE, MN
    ZIP 55767
  • Facility Phone: 218 249-5357
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: JACQUELINE VOLK
  • NPI Number: 1649922485
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 24D2264643
LAB Type Ambulatory Surgery Center
Facility Name NORTHERN LAKES SURGERY CENTER LLC
Street 4791 COUNTY ROAD 10
City MOOSE LAKE
State MN
ZIP 55767
Phone 218 249-5357
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/18/2024
Certificate Expiration Date 7/17/2026
Facility Type Ambulatory Surgery Center
Lab Director JACQUELINE VOLK

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