52D0393163 CLIA NUMBER - SSM HEALTH DEAN MEDICAL GROUP - STOUGHTON

Laboratory Demographics

CLIA Number: 52D0393163

Facility Name: SSM HEALTH DEAN MEDICAL GROUP - STOUGHTON

Facility Address:
225 CHURCH ST
STOUGHTON, WI
ZIP 53589
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Facility Phone Number: 608 824-4388

Facility Type: Physician Office

Certificate Type: Certificate of Compliance

NPI Number: 1699786517

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	52D0393163
LAB Type	Physician Office
Facility Name	SSM HEALTH DEAN MEDICAL GROUP - STOUGHTON
Street	225 CHURCH ST
City	STOUGHTON
State	WI
ZIP	53589
Phone	608 824-4388
CertificateType	2
CertificateEffectiveDate	1/27/2024
CertificateExpirationDate	1/26/2026
FacilityType	Compliance

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