52D0984714 CLIA NUMBER - THERESA AMBULANCE SERVICE

Laboratory Demographics

  • CLIA Code: 52D0984714
  • Facility Name: THERESA AMBULANCE SERVICE
  • Facility Address: 303 DEPOT RD
    THERESA, WI
    ZIP 53091
  • Facility Phone: 920 488-6301
  • Facility Type: Ambulance
  • Facility Type: Waiver
  • Lab Director: CHARLES TRAUBA
  • NPI Number: 1104804657
  • Taxonomy: 3416L0300X - Ambulance

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CLIA Record

Field Name Field Value
CLIA Number 52D0984714
LAB Type Ambulance
Facility Name THERESA AMBULANCE SERVICE
Street 303 DEPOT RD
City THERESA
State WI
ZIP 53091
Phone 920 488-6301
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/28/2025
Certificate Expiration Date 3/27/2027
Facility Type Ambulance
Lab Director CHARLES TRAUBA

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