52D0717468 CLIA NUMBER - GREEN BAY SURGICAL CENTER LTD

Laboratory Demographics

  • CLIA Code: 52D0717468
  • Facility Name: GREEN BAY SURGICAL CENTER LTD
  • Facility Address: 704 S WEBSTER AVE
    GREEN BAY, WI
    ZIP 54301
  • Facility Phone: 920 432-7433
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: DR. JAMES LEE
  • NPI Number: 1194822411
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 52D0717468
LAB Type Ambulatory Surgery Center
Facility Name GREEN BAY SURGICAL CENTER LTD
Street 704 S WEBSTER AVE
City GREEN BAY
State WI
ZIP 54301
Phone 920 432-7433
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Ambulatory Surgery Center
Lab Director DR. JAMES LEE

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