35D2128620 CLIA NUMBER - COMMUNITY MEDICAL SERVICES - FARGO

Laboratory Demographics

CLIA Number: 35D2128620

Facility Name: COMMUNITY MEDICAL SERVICES - FARGO

Facility Address:
901 28TH ST S, SUITE C
FARGO, ND
ZIP 58103
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Facility Phone Number: 701 540-6468

Facility Type: Other - OP TREATMENT PROGRAM

Certificate Type: Waiver

NPI Number: 1023039278

Taxonomy: 261QM1200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	35D2128620
LAB Type	Other - OP TREATMENT PROGRAM
Facility Name	COMMUNITY MEDICAL SERVICES - FARGO
Street	901 28TH ST S, SUITE C
City	FARGO
State	ND
ZIP	58103
Phone	701 540-6468
CertificateType	4
CertificateEffectiveDate	4/3/2023
CertificateExpirationDate	4/2/2025
FacilityType	Waiver

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