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52D0388385 CLIA NUMBER - PROHEALTH MEDICAL GROUP, INC - HARTLAND

Laboratory Demographics

CLIA Number: 52D0388385

Facility Name: PROHEALTH MEDICAL GROUP, INC - HARTLAND

Facility Address:
1500 WALNUT RIDGE DR
HARTLAND, WI
ZIP 53029
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Facility Phone Number: 262 513-7500

Facility Type: Community Clinic

Certificate Type: Waiver
NPI Number: 1386785178

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name Field Value
CLIA Number 52D0388385
LAB Type Community Clinic
Facility Name PROHEALTH MEDICAL GROUP, INC - HARTLAND
Street 1500 WALNUT RIDGE DR
City HARTLAND
State WI
ZIP 53029
Phone 262 513-7500
CertificateType 4
CertificateEffectiveDate 11/5/2023
CertificateExpirationDate 11/4/2025
FacilityType Waiver

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