52D1008743 CLIA NUMBER - CITY OF FOND DU LAC FIRE DEPARTMENT

Laboratory Demographics

CLIA Number: 52D1008743

Facility Name: CITY OF FOND DU LAC FIRE DEPARTMENT

Facility Address:
815 S MAIN ST
FOND DU LAC, WI
ZIP 54935
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Facility Phone Number: 920 322-3800

Facility Type: Ambulance

Certificate Type: Waiver

NPI Number: 1619025889

Taxonomy: 3416L0300X - Ambulance

CLIA Record

Field Name	Field Value
CLIA Number	52D1008743
LAB Type	Ambulance
Facility Name	CITY OF FOND DU LAC FIRE DEPARTMENT
Street	815 S MAIN ST
City	FOND DU LAC
State	WI
ZIP	54935
Phone	920 322-3800
CertificateType	4
CertificateEffectiveDate	1/27/2023
CertificateExpirationDate	1/26/2025
FacilityType	Waiver

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