52D0393107 CLIA NUMBER - PRAIRIE CLINIC

Laboratory Demographics

CLIA Number: 52D0393107

Facility Name: PRAIRIE CLINIC

Facility Address:
112 HELEN ST
SAUK CITY, WI
ZIP 53583
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Facility Phone Number: 608 643-3351

Facility Type: Physician Office

Certificate Type: Certificate of Compliance

NPI Number: 1407060791

Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies
A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.

CLIA Record

Field Name	Field Value
CLIA Number	52D0393107
LAB Type	Physician Office
Facility Name	PRAIRIE CLINIC
Street	112 HELEN ST
City	SAUK CITY
State	WI
ZIP	53583
Phone	608 643-3351
CertificateType	2
CertificateEffectiveDate	12/10/2023
CertificateExpirationDate	12/9/2025
FacilityType	Compliance

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