35D2253048 CLIA NUMBER - MEDPARK SPECIALIZED SURGERY

Laboratory Demographics

  • CLIA Code: 35D2253048
  • Facility Name: MEDPARK SPECIALIZED SURGERY
  • Facility Address: 4450 31ST AVE S SUITE 201
    FARGO, ND
    ZIP 58104
  • Facility Phone: (701) 951-2020
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: LESLIE HEITKAMP
  • NPI Number: 1184375545
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 35D2253048
LAB Type Ambulatory Surgery Center
Facility Name MEDPARK SPECIALIZED SURGERY
Street 4450 31ST AVE S SUITE 201
City FARGO
State ND
ZIP 58104
Phone 7019512020
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/16/2026
Certificate Expiration Date 2/15/2028
Facility Type Ambulatory Surgery Center
Lab Director LESLIE HEITKAMP

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This page was last updated on: 5/18/2026