52D0912407 CLIA NUMBER - WATERTOWN REGIONAL MEDICAL CENTER - JUNEAU CLINIC

Laboratory Demographics

  • CLIA Code: 52D0912407
  • Facility Name: WATERTOWN REGIONAL MEDICAL CENTER - JUNEAU CLINIC
  • Facility Address: 334 S WESTERN AVE
    JUNEAU, WI
    ZIP 53039
  • Facility Phone: 920 386-0290
  • Facility Type: Other - OFF-CAMPUS PROVIDER BASED
  • Facility Type: Waiver
  • Lab Director: DR. WHITNEY M. VAN REESEN
  • NPI Number: 1689853210
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 52D0912407
LAB Type Other - OFF-CAMPUS PROVIDER BASED
Facility Name WATERTOWN REGIONAL MEDICAL CENTER - JUNEAU CLINIC
Street 334 S WESTERN AVE
City JUNEAU
State WI
ZIP 53039
Phone 920 386-0290
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/1/2024
Certificate Expiration Date 2/28/2026
Facility Type Other - OFF-CAMPUS PROVIDER BASED
Lab Director DR. WHITNEY M. VAN REESEN

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This page was last updated on: 3/20/2025