35D2110160 CLIA NUMBER - ESSENTIA HEALTH 52ND AVENUE CLINIC

Laboratory Demographics

  • CLIA Code: 35D2110160
  • Facility Name: ESSENTIA HEALTH 52ND AVENUE CLINIC
  • Facility Address: 4110 51ST AVE S
    FARGO, ND
    ZIP 58104
  • Facility Phone: 701 364-3110
  • Facility Type: Community Clinic
  • Facility Type: Accreditation
  • Lab Director: AMANDA BUETTNER
  • NPI Number: 1144776576
  • Taxonomy: 261QM1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 35D2110160
LAB Type Community Clinic
Facility Name ESSENTIA HEALTH 52ND AVENUE CLINIC
Street 4110 51ST AVE S
City FARGO
State ND
ZIP 58104
Phone 701 364-3110
Certificate Type Certificate of Accreditation
Certificate Type Description This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.
Certificate Effective Date 6/28/2025
Certificate Expiration Date 6/27/2027
Facility Type Community Clinic
Lab Director AMANDA BUETTNER

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This page was last updated on: 9/29/2025