43D2117626 CLIA NUMBER - AVERA MEDICAL GROUP BROOKINGS SPECIALTY CARE

Laboratory Demographics

CLIA Number: 43D2117626

Facility Name: AVERA MEDICAL GROUP BROOKINGS SPECIALTY CARE

Facility Address:
310 22 ND AVENUE
BROOKINGS, SD
ZIP 57006
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Facility Phone Number: 605 696-2700

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1982057246

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	43D2117626
LAB Type	Physician Office
Facility Name	AVERA MEDICAL GROUP BROOKINGS SPECIALTY CARE
Street	310 22 ND AVENUE
City	BROOKINGS
State	SD
ZIP	57006
Phone	605 696-2700
CertificateType	3
CertificateEffectiveDate	8/19/2022
CertificateExpirationDate	8/18/2024
FacilityType	PPMP

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This page was last updated on: 4/23/2024