52D0989948 CLIA NUMBER - PLYMOUTH FIRE DEPT AMBULANCE SQUAD

Laboratory Demographics

CLIA Number: 52D0989948

Facility Name: PLYMOUTH FIRE DEPT AMBULANCE SQUAD

Facility Address:
111 E MAIN ST P O BOX 294
PLYMOUTH, WI
ZIP 53073
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Facility Phone Number: 920 893-1331

Facility Type: Ambulance

Certificate Type: Waiver

NPI Number: 1992905418

Taxonomy: 3416L0300X - Ambulance

CLIA Record

Field Name	Field Value
CLIA Number	52D0989948
LAB Type	Ambulance
Facility Name	PLYMOUTH FIRE DEPT AMBULANCE SQUAD
Street	111 E MAIN ST P O BOX 294
City	PLYMOUTH
State	WI
ZIP	53073
Phone	920 893-1331
CertificateType	4
CertificateEffectiveDate	8/9/2023
CertificateExpirationDate	8/8/2025
FacilityType	Waiver

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