52D1009669 CLIA NUMBER - AMG MISHICOT

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CLIA Record

Field Name Field Value
CLIA Number 52D1009669
LAB Type Physician Office
Facility Name AMG MISHICOT
Street 175 S STATE ST
City MISHICOT
State WI
ZIP 54228
Phone 920 793-7004
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2025
Certificate Expiration Date 8/31/2027
Facility Type Physician Office
Lab Director BRITTANY BOCKELMAN

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This page was last updated on: 9/29/2025