52D1025705 CLIA NUMBER - BOUC FAMILY WELLNESS CENTER, LLC

Laboratory Demographics

CLIA Number: 52D1025705

Facility Name: BOUC FAMILY WELLNESS CENTER, LLC

Facility Address:
3005 RIVERSIDE DR STE 101
BELOIT, WI
ZIP 53511
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Facility Phone Number: 608 365-7200

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1356520563

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name	Field Value
CLIA Number	52D1025705
LAB Type	Physician Office
Facility Name	BOUC FAMILY WELLNESS CENTER, LLC
Street	3005 RIVERSIDE DR STE 101
City	BELOIT
State	WI
ZIP	53511
Phone	608 365-7200
CertificateType	3
CertificateEffectiveDate	5/14/2024
CertificateExpirationDate	5/13/2026
FacilityType	PPMP

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