35D2176659 CLIA NUMBER - DR JEREMIAH J GLOSENGER, PC

Laboratory Demographics

CLIA Number: 35D2176659

Facility Name: DR JEREMIAH J GLOSENGER, PC

Facility Address:
2615 ELK DR STE 3
MINOT, ND
ZIP 58701
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Facility Phone Number: 701 852-3421

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1649816828

Taxonomy: 261QS0112X - Clinic/Center
An oral and maxillofacial surgery clinic or center specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.

CLIA Record

Field Name	Field Value
CLIA Number	35D2176659
LAB Type	Ambulatory Surgery Center
Facility Name	DR JEREMIAH J GLOSENGER, PC
Street	2615 ELK DR STE 3
City	MINOT
State	ND
ZIP	58701
Phone	701 852-3421
CertificateType	4
CertificateEffectiveDate	12/19/2023
CertificateExpirationDate	12/18/2025
FacilityType	Waiver

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