52D1034924 CLIA NUMBER - ARTHROSCOPIC SURGERY CENTER LLC SPORTS MEDICINE CENTER

Laboratory Demographics

  • CLIA Code: 52D1034924
  • Facility Name: ARTHROSCOPIC SURGERY CENTER LLC SPORTS MEDICINE CENTER
  • Facility Address: 277 ALTENHOFEN DR
    APPLETON, WI
    ZIP 54913
  • Facility Phone: 920 993-1643
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: DR. ETIENNE A. MEJIA
  • NPI Number: 1134140122
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 52D1034924
LAB Type Ambulatory Surgery Center
Facility Name ARTHROSCOPIC SURGERY CENTER LLC SPORTS MEDICINE CENTER
Street 277 ALTENHOFEN DR
City APPLETON
State WI
ZIP 54913
Phone 920 993-1643
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/16/2024
Certificate Expiration Date 12/15/2026
Facility Type Ambulatory Surgery Center
Lab Director DR. ETIENNE A. MEJIA

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