35D2184037 CLIA NUMBER - CHATTER PEDIATRIC WALK-IN CLINC

Laboratory Demographics

CLIA Number: 35D2184037

Facility Name: CHATTER PEDIATRIC WALK-IN CLINC

Facility Address:
221 UNIVERSITY AVE STE 102
WILLISTON, ND
ZIP 58801
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Facility Phone Number: 701 580-8788

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1366087264

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	35D2184037
LAB Type	Practitioner Other
Facility Name	CHATTER PEDIATRIC WALK-IN CLINC
Street	221 UNIVERSITY AVE STE 102
City	WILLISTON
State	ND
ZIP	58801
Phone	701 580-8788
CertificateType	4
CertificateEffectiveDate	5/14/2024
CertificateExpirationDate	5/13/2026
FacilityType	Waiver

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