52D0388702 CLIA NUMBER - SHEBOYGAN PEDIATRIC ASSOCIATES SC

Laboratory Demographics

  • CLIA Code: 52D0388702
  • Facility Name: SHEBOYGAN PEDIATRIC ASSOCIATES SC
  • Facility Address: 2920 SUPERIOR AVENUE
    SHEBOYGAN, WI
    ZIP 53081
  • Facility Phone: 920 458-3331
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: TAYLOR VICKI
  • NPI Number: 1134285182
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 52D0388702
LAB Type Physician Office
Facility Name SHEBOYGAN PEDIATRIC ASSOCIATES SC
Street 2920 SUPERIOR AVENUE
City SHEBOYGAN
State WI
ZIP 53081
Phone 920 458-3331
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/5/2025
Certificate Expiration Date 8/4/2027
Facility Type Physician Office
Lab Director TAYLOR VICKI

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