35D1088791 CLIA NUMBER - ESSENTIA HEALTH - OSGOOD

Laboratory Demographics

CLIA Number: 35D1088791

Facility Name: ESSENTIA HEALTH - OSGOOD

Facility Address:
4622 40TH AVE S
FARGO, ND
ZIP 58104
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Facility Phone Number: 701 364-7342

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1619123593

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	35D1088791
LAB Type	Physician Office
Facility Name	ESSENTIA HEALTH - OSGOOD
Street	4622 40TH AVE S
City	FARGO
State	ND
ZIP	58104
Phone	701 364-7342
CertificateType	4
CertificateEffectiveDate	9/4/2022
CertificateExpirationDate	9/3/2024
FacilityType	Waiver

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