52D0663335 CLIA NUMBER - SSM HEALTH DEAN MEDICAL GROUP - EVANSVILLE

Laboratory Demographics

  • CLIA Code: 52D0663335
  • Facility Name: SSM HEALTH DEAN MEDICAL GROUP - EVANSVILLE
  • Facility Address: 10 N WATER ST
    EVANSVILLE, WI
    ZIP 53536
  • Facility Phone: 608 371-8379
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MS. JANIE M. CARROLL
  • NPI Number: 1619911633
  • Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies

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CLIA Record

Field Name Field Value
CLIA Number 52D0663335
LAB Type Physician Office
Facility Name SSM HEALTH DEAN MEDICAL GROUP - EVANSVILLE
Street 10 N WATER ST
City EVANSVILLE
State WI
ZIP 53536
Phone 608 371-8379
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/7/2024
Certificate Expiration Date 4/6/2026
Facility Type Physician Office
Lab Director MS. JANIE M. CARROLL

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This page was last updated on: 6/4/2025