52D0982945 CLIA NUMBER - BLACK CREEK RESCUE

Laboratory Demographics

  • CLIA Code: 52D0982945
  • Facility Name: BLACK CREEK RESCUE
  • Facility Address: W5200 CTY RD B
    BLACK CREEK, WI
    ZIP 54106
  • Facility Phone: 920 984-3444
  • Facility Type: Ambulance
  • Facility Type: Waiver
  • Lab Director: KATHY F. PASCH
  • NPI Number: 1942233648
  • Taxonomy: 341600000X - Ambulance

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CLIA Record

Field Name Field Value
CLIA Number 52D0982945
LAB Type Ambulance
Facility Name BLACK CREEK RESCUE
Street W5200 CTY RD B
City BLACK CREEK
State WI
ZIP 54106
Phone 920 984-3444
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/9/2025
Certificate Expiration Date 2/8/2027
Facility Type Ambulance
Lab Director KATHY F. PASCH

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