35D2315212 CLIA NUMBER - MOSAIC DERMATOLOGY PLLC

Laboratory Demographics

  • CLIA Code: 35D2315212
  • Facility Name: MOSAIC DERMATOLOGY PLLC
  • Facility Address: 567 32ND AVE E, SUITE 100
    WEST FARGO, ND
    ZIP 58078
  • Facility Phone: 701 941-3100
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: JOANNE MONTGOMERY
  • NPI Number: 1245051390
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 35D2315212
LAB Type Physician Office
Facility Name MOSAIC DERMATOLOGY PLLC
Street 567 32ND AVE E, SUITE 100
City WEST FARGO
State ND
ZIP 58078
Phone 701 941-3100
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 12/9/2024
Certificate Expiration Date 12/8/2026
Facility Type Physician Office
Lab Director JOANNE MONTGOMERY

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This page was last updated on: 9/29/2025