52D0921803 CLIA NUMBER - PORT WASHINGTON FIRE DEPT AMBULANCE

Laboratory Demographics

  • CLIA Code: 52D0921803
  • Facility Name: PORT WASHINGTON FIRE DEPT AMBULANCE
  • Facility Address: 104 WEST WASHINGTON ST
    PORT WASHINGTON, WI
    ZIP 53074
  • Facility Phone: 262 284-2891
  • Facility Type: Ambulance
  • Facility Type: Waiver
  • Lab Director: MR. MARK D. MITCHELL
  • NPI Number: 1992396360
  • Taxonomy: 122300000X - Dentist

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CLIA Record

Field Name Field Value
CLIA Number 52D0921803
LAB Type Ambulance
Facility Name PORT WASHINGTON FIRE DEPT AMBULANCE
Street 104 WEST WASHINGTON ST
City PORT WASHINGTON
State WI
ZIP 53074
Phone 262 284-2891
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/6/2024
Certificate Expiration Date 11/5/2026
Facility Type Ambulance
Lab Director MR. MARK D. MITCHELL

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