35D2247496 CLIA NUMBER - LIVING WELL DAKOTA

Laboratory Demographics

CLIA Number: 35D2247496

Facility Name: LIVING WELL DAKOTA

Facility Address:
1140 W CAPITOL AVE
BISMARCK, ND
ZIP 58501
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Facility Phone Number: 701 204-7706

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1619647211

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	35D2247496
LAB Type	Physician Office
Facility Name	LIVING WELL DAKOTA
Street	1140 W CAPITOL AVE
City	BISMARCK
State	ND
ZIP	58501
Phone	701 204-7706
CertificateType	4
CertificateEffectiveDate	1/6/2024
CertificateExpirationDate	1/5/2026
FacilityType	Waiver

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