52D0697015 CLIA NUMBER - ASPIRUS CRANDON CLINIC

Laboratory Demographics

CLIA Number: 52D0697015

Facility Name: ASPIRUS CRANDON CLINIC

Facility Address:
400 W GLEN ST
CRANDON, WI
ZIP 54520
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Facility Phone Number: 715 478-6306

Facility Type: Rural Health Clinic

Certificate Type: Waiver

NPI Number: 1699068692

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	52D0697015
LAB Type	Rural Health Clinic
Facility Name	ASPIRUS CRANDON CLINIC
Street	400 W GLEN ST
City	CRANDON
State	WI
ZIP	54520
Phone	715 478-6306
CertificateType	4
CertificateEffectiveDate	4/19/2023
CertificateExpirationDate	4/18/2025
FacilityType	Waiver

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