24D2293765 CLIA NUMBER - FAIRVIEW MAPLE GROVE AMBULATORY SURGEY CENTER, LLC

Laboratory Demographics

  • CLIA Code: 24D2293765
  • Facility Name: FAIRVIEW MAPLE GROVE AMBULATORY SURGEY CENTER, LLC
  • Facility Address: 14500 99TH AVENUE NORTH
    MAPLE GROVE, MN
    ZIP 55369
  • Facility Phone: 763 898-1000
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: ASHLEY HALE
  • NPI Number: 1841315165
  • Taxonomy: 261QM1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 24D2293765
LAB Type Ambulatory Surgery Center
Facility Name FAIRVIEW MAPLE GROVE AMBULATORY SURGEY CENTER, LLC
Street 14500 99TH AVENUE NORTH
City MAPLE GROVE
State MN
ZIP 55369
Phone 763 898-1000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/14/2023
Certificate Expiration Date 11/13/2025
Facility Type Ambulatory Surgery Center
Lab Director ASHLEY HALE

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