52D0393240 CLIA NUMBER - SSM HEALTH DEAN MEDICAL GROUP - WATERLOO

Laboratory Demographics

  • CLIA Code: 52D0393240
  • Facility Name: SSM HEALTH DEAN MEDICAL GROUP - WATERLOO
  • Facility Address: 105 HIGHLAND TER
    WATERLOO, WI
    ZIP 53594
  • Facility Phone: 920 478-2141
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JEFFREY J. MAXWELL
  • NPI Number: 1811931835
  • Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies

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CLIA Record

Field Name Field Value
CLIA Number 52D0393240
LAB Type Physician Office
Facility Name SSM HEALTH DEAN MEDICAL GROUP - WATERLOO
Street 105 HIGHLAND TER
City WATERLOO
State WI
ZIP 53594
Phone 920 478-2141
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/27/2024
Certificate Expiration Date 12/26/2026
Facility Type Physician Office
Lab Director JEFFREY J. MAXWELL

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