52D1019170 CLIA NUMBER - OCCUPATIONAL HEALTH & SPORTS MEDICINE CENTER

Laboratory Demographics

  • CLIA Code: 52D1019170
  • Facility Name: OCCUPATIONAL HEALTH & SPORTS MEDICINE CENTER
  • Facility Address: 1650 LEE LN
    BELOIT, WI
    ZIP 53511
  • Facility Phone: 608 364-4666
  • Facility Type: Other - OCCUPATIONAL HEALTH CNTR
  • Facility Type: Waiver
  • Lab Director: MIKE KORBOL
  • NPI Number: 1912199340
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 52D1019170
LAB Type Other - OCCUPATIONAL HEALTH CNTR
Facility Name OCCUPATIONAL HEALTH & SPORTS MEDICINE CENTER
Street 1650 LEE LN
City BELOIT
State WI
ZIP 53511
Phone 608 364-4666
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/12/2023
Certificate Expiration Date 11/11/2025
Facility Type Other - OCCUPATIONAL HEALTH CNTR
Lab Director MIKE KORBOL

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