43D0047742 CLIA NUMBER - AVERA MEDICAL GROUP FAIRFAX

Laboratory Demographics

  • CLIA Code: 43D0047742
  • Facility Name: AVERA MEDICAL GROUP FAIRFAX
  • Facility Address: MAIN ST PO BOX 354
    FAIRFAX, SD
    ZIP 57335
  • Facility Phone: 605 654-2366
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: RICHARD G. KAFKA
  • NPI Number: 1215967203
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 43D0047742
LAB Type Physician Office
Facility Name AVERA MEDICAL GROUP FAIRFAX
Street MAIN ST PO BOX 354
City FAIRFAX
State SD
ZIP 57335
Phone 605 654-2366
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 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director RICHARD G. KAFKA

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