52D0397130 CLIA NUMBER - SHELL LAKE CLINIC LTD

Laboratory Demographics

  • CLIA Code: 52D0397130
  • Facility Name: SHELL LAKE CLINIC LTD
  • Facility Address: 105 4TH STREET PO BOX 336
    SHELL LAKE, WI
    ZIP 54871
  • Facility Phone: 715 468-2711
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: DR. ALAN J. HAESEMEYER
  • NPI Number: 1083722805
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 52D0397130
LAB Type Rural Health Clinic
Facility Name SHELL LAKE CLINIC LTD
Street 105 4TH STREET PO BOX 336
City SHELL LAKE
State WI
ZIP 54871
Phone 715 468-2711
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/21/2025
Certificate Expiration Date 6/20/2027
Facility Type Rural Health Clinic
Lab Director DR. ALAN J. HAESEMEYER

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