52D1024853 CLIA NUMBER - KENOSHA VA CBOC

Laboratory Demographics

  • CLIA Code: 52D1024853
  • Facility Name: KENOSHA VA CBOC
  • Facility Address: 8207 22ND AVENUE
    KENOSHA, WI
    ZIP 53143
  • Facility Phone: 262 653-9286
  • Facility Type: Community Clinic
  • Facility Type: Accreditation
  • Lab Director: JOSHUA BUSS
  • NPI Number: 1033246152
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 52D1024853
LAB Type Community Clinic
Facility Name KENOSHA VA CBOC
Street 8207 22ND AVENUE
City KENOSHA
State WI
ZIP 53143
Phone 262 653-9286
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 4/22/2004
Certificate Expiration Date 5/22/2026
Facility Type Community Clinic
Lab Director JOSHUA BUSS

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