35D0971313 CLIA NUMBER - INDEPENDENT PRACTITIONERS OF AMERICA LLC

Laboratory Demographics

CLIA Number: 35D0971313

Facility Name: INDEPENDENT PRACTITIONERS OF AMERICA LLC

Facility Address:
115 W CENTURY AVE SUITE B CENTURY MEDICAL PARK STE B
BISMARCK, ND
ZIP 58503
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Facility Phone Number: 701 255-3311

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1538189907

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	35D0971313
LAB Type	Physician Office
Facility Name	INDEPENDENT PRACTITIONERS OF AMERICA LLC
Street	115 W CENTURY AVE SUITE B CENTURY MEDICAL PARK STE B
City	BISMARCK
State	ND
ZIP	58503
Phone	701 255-3311
CertificateType	4
CertificateEffectiveDate	3/10/2024
CertificateExpirationDate	3/9/2026
FacilityType	Waiver

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