43D2306126 CLIA NUMBER - MIDWEST STREET MEDICINE

Laboratory Demographics

  • CLIA Code: 43D2306126
  • Facility Name: MIDWEST STREET MEDICINE
  • Facility Address: 605 S NICHOLAS CIRCLE
    BRANDON, SD
    ZIP 57005
  • Facility Phone: 605 370-3054
  • Facility Type: Mobile Laboratory
  • Facility Type: Waiver
  • Lab Director: SHANNON D. EMRY
  • NPI Number: 1154159747
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 43D2306126
LAB Type Mobile Laboratory
Facility Name MIDWEST STREET MEDICINE
Street 605 S NICHOLAS CIRCLE
City BRANDON
State SD
ZIP 57005
Phone 605 370-3054
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/12/2024
Certificate Expiration Date 6/11/2026
Facility Type Mobile Laboratory
Lab Director SHANNON D. EMRY

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