35D2110160 CLIA NUMBER - ESSENTIA HEALTH - 52ND AVENUE CLINIC

Laboratory Demographics

CLIA Number: 35D2110160

Facility Name: ESSENTIA HEALTH - 52ND AVENUE CLINIC

Facility Address:
4110 51ST AVE S
FARGO, ND
ZIP 58104
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Facility Phone Number: 701 364-3335

Facility Type: Physician Office

Certificate Type: Accreditation

NPI Number: 1144776576

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	35D2110160
LAB Type	Physician Office
Facility Name	ESSENTIA HEALTH - 52ND AVENUE CLINIC
Street	4110 51ST AVE S
City	FARGO
State	ND
ZIP	58104
Phone	701 364-3335
CertificateType	1
CertificateEffectiveDate	6/28/2023
CertificateExpirationDate	6/27/2025
FacilityType	Accreditation

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