35D2083007 CLIA NUMBER - PRAIRIE ST JOHN'S

Laboratory Demographics

  • CLIA Code: 35D2083007
  • Facility Name: PRAIRIE ST JOHN'S
  • Facility Address: SAINT STEPHENS 334 6TH AVE S
    FARGO, ND
    ZIP 58103
  • Facility Phone: (701) 476-7200
  • Facility Type: Ancillary Testing Site in Health Care Center
  • Facility Type: Waiver
  • Lab Director: DR. ERIC C. TEE
  • NPI Number: 1366681918
  • Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility

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CLIA Record

Field Name Field Value
CLIA Number 35D2083007
LAB Type Ancillary Testing Site in Health Care Center
Facility Name PRAIRIE ST JOHN'S
Street SAINT STEPHENS 334 6TH AVE S
City FARGO
State ND
ZIP 58103
Phone 7014767200
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/26/2024
Certificate Expiration Date 8/25/2026
Facility Type Ancillary Testing Site in Health Care Center
Lab Director DR. ERIC C. TEE

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