43D1039717 CLIA NUMBER - PRAIRIE HEALTH CLINIC - STICKNEY

Laboratory Demographics

  • CLIA Code: 43D1039717
  • Facility Name: PRAIRIE HEALTH CLINIC - STICKNEY
  • Facility Address: 301 MAIN PO BOX 14
    STICKNEY, SD
    ZIP 57375
  • Facility Phone: 605 732-4508
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: MAURICE CHESSMORE
  • NPI Number: 1558464446
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 43D1039717
LAB Type Community Clinic
Facility Name PRAIRIE HEALTH CLINIC - STICKNEY
Street 301 MAIN PO BOX 14
City STICKNEY
State SD
ZIP 57375
Phone 605 732-4508
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/20/2025
Certificate Expiration Date 4/19/2027
Facility Type Community Clinic
Lab Director MAURICE CHESSMORE

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