52D0393950 CLIA NUMBER - SSM HEALTH DEAN MEDICAL GROUP -PORTAGE

Laboratory Demographics

  • CLIA Code: 52D0393950
  • Facility Name: SSM HEALTH DEAN MEDICAL GROUP -PORTAGE
  • Facility Address: 2825 HUNTERS TRAIL
    PORTAGE, WI
    ZIP 53901
  • Facility Phone: 608 356-1492
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: JEFFREY J. MAXWELL
  • NPI Number: 1427085679
  • Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies

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CLIA Record

Field Name Field Value
CLIA Number 52D0393950
LAB Type Physician Office
Facility Name SSM HEALTH DEAN MEDICAL GROUP -PORTAGE
Street 2825 HUNTERS TRAIL
City PORTAGE
State WI
ZIP 53901
Phone 608 356-1492
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 5/20/2025
Certificate Expiration Date 5/19/2027
Facility Type Physician Office
Lab Director JEFFREY J. MAXWELL

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