52D0396816 CLIA NUMBER - GUNDERSEN TRI COUNTY HOSPITAL AND CLINICS INDEPENDENCE

Laboratory Demographics

  • CLIA Code: 52D0396816
  • Facility Name: GUNDERSEN TRI COUNTY HOSPITAL AND CLINICS INDEPENDENCE
  • Facility Address: 35791 OSSEO RD
    INDEPENDENCE, WI
    ZIP 54747
  • Facility Phone: 715 985-2351
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MS. DARCY J. GOPLIN
  • NPI Number: 1780636480
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 52D0396816
LAB Type Physician Office
Facility Name GUNDERSEN TRI COUNTY HOSPITAL AND CLINICS INDEPENDENCE
Street 35791 OSSEO RD
City INDEPENDENCE
State WI
ZIP 54747
Phone 715 985-2351
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/29/2024
Certificate Expiration Date 2/27/2026
Facility Type Physician Office
Lab Director MS. DARCY J. GOPLIN

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