52D0986049 CLIA NUMBER - MOSINEE FIRE DISTRICT

Laboratory Demographics

CLIA Number: 52D0986049

Facility Name: MOSINEE FIRE DISTRICT

Facility Address:
601 S RANGELINE RD
MOSINEE, WI
ZIP 54455
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Facility Phone Number: 715 693-2059

Facility Type: Ambulance

Certificate Type: Waiver

NPI Number: 1770537474

Taxonomy: 3416L0300X - Ambulance

CLIA Record

Field Name	Field Value
CLIA Number	52D0986049
LAB Type	Ambulance
Facility Name	MOSINEE FIRE DISTRICT
Street	601 S RANGELINE RD
City	MOSINEE
State	WI
ZIP	54455
Phone	715 693-2059
CertificateType	4
CertificateEffectiveDate	5/7/2023
CertificateExpirationDate	5/6/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024