52D0999850 CLIA NUMBER - UNION GROVE CBOC

Laboratory Demographics

CLIA Number: 52D0999850

Facility Name: UNION GROVE CBOC

Facility Address:
21425 SPRING ST
UNION GROVE, WI
ZIP 53182
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Facility Phone Number: 414 384-2000

Facility Type: Community Clinic

Certificate Type: Accreditation

NPI Number: 1881290872

Taxonomy: 261QD0000X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	52D0999850
LAB Type	Community Clinic
Facility Name	UNION GROVE CBOC
Street	21425 SPRING ST
City	UNION GROVE
State	WI
ZIP	53182
Phone	414 384-2000
CertificateType	1
CertificateEffectiveDate	5/24/2002
CertificateExpirationDate	5/22/2026
FacilityType	Accreditation

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