35D0408773 CLIA NUMBER - AVERA CLINIC OF ELLENDALE

Laboratory Demographics

  • CLIA Code: 35D0408773
  • Facility Name: AVERA CLINIC OF ELLENDALE
  • Facility Address: 240 MAIN
    ELLENDALE, ND
    ZIP 58436
  • Facility Phone: 701 349-3666
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: DR. JONATHON E. OLSON
  • NPI Number: 1760423057
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 35D0408773
LAB Type Rural Health Clinic
Facility Name AVERA CLINIC OF ELLENDALE
Street 240 MAIN
City ELLENDALE
State ND
ZIP 58436
Phone 701 349-3666
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/7/2023
Certificate Expiration Date 12/6/2025
Facility Type Rural Health Clinic
Lab Director DR. JONATHON E. OLSON

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