43D0921384 CLIA NUMBER - AVERA MEDICAL GROUP CLINIC - REVILLO, SD

Laboratory Demographics

  • CLIA Code: 43D0921384
  • Facility Name: AVERA MEDICAL GROUP CLINIC - REVILLO, SD
  • Facility Address: 305 N 2ND AVENUE POST OFFICE BOX 6
    REVILLO, SD
    ZIP 57259
  • Facility Phone: 605 623-4695
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: EMELIA NELSON
  • NPI Number: 1588677892
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 43D0921384
LAB Type Physician Office
Facility Name AVERA MEDICAL GROUP CLINIC - REVILLO, SD
Street 305 N 2ND AVENUE POST OFFICE BOX 6
City REVILLO
State SD
ZIP 57259
Phone 605 623-4695
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/8/2024
Certificate Expiration Date 1/7/2026
Facility Type Physician Office
Lab Director EMELIA NELSON

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