52D0693164 CLIA NUMBER - SOKAOGON CHIPPEWA HEALTH CLINIC

Laboratory Demographics

  • CLIA Code: 52D0693164
  • Facility Name: SOKAOGON CHIPPEWA HEALTH CLINIC
  • Facility Address: 3144 VANZILE RD
    CRANDON, WI
    ZIP 54520
  • Facility Phone: 715 478-5180
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: DR. EUNICE CORUJO-INCHA
  • NPI Number: 1033115456
  • Taxonomy: 261QF0400X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 52D0693164
LAB Type Rural Health Clinic
Facility Name SOKAOGON CHIPPEWA HEALTH CLINIC
Street 3144 VANZILE RD
City CRANDON
State WI
ZIP 54520
Phone 715 478-5180
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/6/2024
Certificate Expiration Date 5/5/2026
Facility Type Rural Health Clinic
Lab Director DR. EUNICE CORUJO-INCHA

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