35D1045420 CLIA NUMBER - ESSENTIA HEALTH MID-DAKOTA BISMARCK 9TH ST CLINI

Laboratory Demographics

CLIA Number: 35D1045420

Facility Name: ESSENTIA HEALTH MID-DAKOTA BISMARCK 9TH ST CLINI

Facility Address:
401 N 9TH ST
BISMARCK, ND
ZIP 58501
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Facility Phone Number: 701 712-4500

Facility Type: Community Clinic

Certificate Type: Waiver

NPI Number: 1366484404

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	35D1045420
LAB Type	Community Clinic
Facility Name	ESSENTIA HEALTH MID-DAKOTA BISMARCK 9TH ST CLINI
Street	401 N 9TH ST
City	BISMARCK
State	ND
ZIP	58501
Phone	701 712-4500
CertificateType	4
CertificateEffectiveDate	9/14/2023
CertificateExpirationDate	9/13/2025
FacilityType	Waiver

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