52D0988660 CLIA NUMBER - KEWASKUM FIRE DEPARTMENT

Laboratory Demographics

CLIA Number: 52D0988660

Facility Name: KEWASKUM FIRE DEPARTMENT

Facility Address:
1106 FOND DU LAC AVE PO BOX 422
KEWASKUM, WI
ZIP 53040
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Facility Phone Number: 262 626-2411

Facility Type: Ambulance

Certificate Type: Waiver

NPI Number: 1396041448

Taxonomy: 3416L0300X - Ambulance

CLIA Record

Field Name	Field Value
CLIA Number	52D0988660
LAB Type	Ambulance
Facility Name	KEWASKUM FIRE DEPARTMENT
Street	1106 FOND DU LAC AVE PO BOX 422
City	KEWASKUM
State	WI
ZIP	53040
Phone	262 626-2411
CertificateType	4
CertificateEffectiveDate	7/3/2023
CertificateExpirationDate	7/2/2025
FacilityType	Waiver

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