52D0980872 CLIA NUMBER - RANDOLPH COMMUNITY CLINIC SC

Laboratory Demographics

  • CLIA Code: 52D0980872
  • Facility Name: RANDOLPH COMMUNITY CLINIC SC
  • Facility Address: 504 S HIGH ST
    RANDOLPH, WI
    ZIP 53956
  • Facility Phone: 920 326-5060
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: MELISSA E. LUCARELLI MD
  • NPI Number: 1801975297
  • Taxonomy: 341600000X - Ambulance

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CLIA Record

Field Name Field Value
CLIA Number 52D0980872
LAB Type Physician Office
Facility Name RANDOLPH COMMUNITY CLINIC SC
Street 504 S HIGH ST
City RANDOLPH
State WI
ZIP 53956
Phone 920 326-5060
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 12/6/2024
Certificate Expiration Date 12/5/2026
Facility Type Physician Office
Lab Director MELISSA E. LUCARELLI MD

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