24D1048160 CLIA NUMBER - ALLINA HEALTH EAGAN WOMEN'S HEALTH CLINIC

Laboratory Demographics

  • CLIA Code: 24D1048160
  • Facility Name: ALLINA HEALTH EAGAN WOMEN'S HEALTH CLINIC
  • Facility Address: 2805 DODD ROAD, SUITE 100
    EAGAN, MN
    ZIP 55121
  • Facility Phone: 612 863-0408
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: MILTON W. DATTA
  • NPI Number: 1376849729
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 24D1048160
LAB Type Community Clinic
Facility Name ALLINA HEALTH EAGAN WOMEN'S HEALTH CLINIC
Street 2805 DODD ROAD, SUITE 100
City EAGAN
State MN
ZIP 55121
Phone 612 863-0408
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/28/2024
Certificate Expiration Date 10/27/2026
Facility Type Community Clinic
Lab Director MILTON W. DATTA

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This page was last updated on: 3/20/2025