35D2203424 CLIA NUMBER - SONTAK FAMILY CLINIC, PLLC

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Laboratory Demographics

CLIA Number: 35D2203424

Facility Name: SONTAK FAMILY CLINIC, PLLC

Facility Address:
4023 STATE ST, SUITE 60
BISMARCK, ND
ZIP 58503
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Facility Phone Number: 701 751-1281

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1174138507

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	35D2203424
LAB Type	Practitioner Other
Facility Name	SONTAK FAMILY CLINIC, PLLC
Street	4023 STATE ST, SUITE 60
City	BISMARCK
State	ND
ZIP	58503
Phone	701 751-1281
CertificateType	4
CertificateEffectiveDate	12/3/2022
CertificateExpirationDate	12/2/2024
FacilityType	Waiver

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