52D2153797 CLIA NUMBER - ST CROIX FALLS CLINIC

Laboratory Demographics

CLIA Number: 52D2153797

Facility Name: ST CROIX FALLS CLINIC

Facility Address:
216 SOUTH ADAMS STREET
ST CROIX FALLS, WI
ZIP 54024
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Facility Phone Number: 715 483-0433

Facility Type: Rural Health Clinic

Certificate Type: Waiver

NPI Number: 1164996997

Taxonomy: 1223G0001X - Dentist
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

CLIA Record

Field Name	Field Value
CLIA Number	52D2153797
LAB Type	Rural Health Clinic
Facility Name	ST CROIX FALLS CLINIC
Street	216 SOUTH ADAMS STREET
City	ST CROIX FALLS
State	WI
ZIP	54024
Phone	715 483-0433
CertificateType	4
CertificateEffectiveDate	8/30/2022
CertificateExpirationDate	8/29/2024
FacilityType	Waiver

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