35D1088791 CLIA NUMBER - ESSENTIA HEALTH - OSGOOD CLINIC

Laboratory Demographics

  • CLIA Code: 35D1088791
  • Facility Name: ESSENTIA HEALTH - OSGOOD CLINIC
  • Facility Address: 4622 40TH AVE S
    FARGO, ND
    ZIP 58104
  • Facility Phone: (701) 364-7342
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KAITLYN E. WILSON
  • NPI Number: 1144776576
  • Taxonomy: 261QM1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 35D1088791
LAB Type Physician Office
Facility Name ESSENTIA HEALTH - OSGOOD CLINIC
Street 4622 40TH AVE S
City FARGO
State ND
ZIP 58104
Phone 7013647342
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/4/2024
Certificate Expiration Date 9/3/2026
Facility Type Physician Office
Lab Director KAITLYN E. WILSON

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This page was last updated on: 5/18/2026