52D0662725 CLIA NUMBER - SHAWANO MENOMINEE COUNTIES HEALTH DEPARTMENT

Laboratory Demographics

CLIA Number: 52D0662725

Facility Name: SHAWANO MENOMINEE COUNTIES HEALTH DEPARTMENT

Facility Address:
311 N MAIN
SHAWANO, WI
ZIP 54166
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Facility Phone Number: 715 526-4808

Facility Type: Public Health Laboratories

Certificate Type: Waiver

NPI Number: 1548260839

Taxonomy: 282NC0060X - General Acute Care Hospital

CLIA Record

Field Name	Field Value
CLIA Number	52D0662725
LAB Type	Public Health Laboratories
Facility Name	SHAWANO MENOMINEE COUNTIES HEALTH DEPARTMENT
Street	311 N MAIN
City	SHAWANO
State	WI
ZIP	54166
Phone	715 526-4808
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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