52D1016783 CLIA NUMBER - CLEVELAND CBOC

Laboratory Demographics

  • CLIA Code: 52D1016783
  • Facility Name: CLEVELAND CBOC
  • Facility Address: 1205 NORTH AVE
    CLEVELAND, WI
    ZIP 53015
  • Facility Phone: 920 693-3750
  • Facility Type: Community Clinic
  • Facility Type: Accreditation
  • Lab Director: THOMAS BRUCKER
  • NPI Number: 1063439966
  • Taxonomy: 164W00000X - Licensed Practical Nurse

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CLIA Record

Field Name Field Value
CLIA Number 52D1016783
LAB Type Community Clinic
Facility Name CLEVELAND CBOC
Street 1205 NORTH AVE
City CLEVELAND
State WI
ZIP 53015
Phone 920 693-3750
Certificate Type Certificate of Accreditation
Certificate Type Description This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.
Certificate Effective Date 9/8/2003
Certificate Expiration Date 5/22/2026
Facility Type Community Clinic
Lab Director THOMAS BRUCKER

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