52D1055819 CLIA NUMBER - VILLAGE OF BRISTOL FIRE RESCUE DEPARTMENT

Laboratory Demographics

CLIA Number: 52D1055819

Facility Name: VILLAGE OF BRISTOL FIRE RESCUE DEPARTMENT

Facility Address:
19801 83RD ST
BRISTOL, WI
ZIP 53104
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Facility Phone Number: 262 857-2711

Facility Type: Ambulance

Certificate Type: Waiver

NPI Number: 1659602290

Taxonomy: 3416L0300X - Ambulance

CLIA Record

Field Name	Field Value
CLIA Number	52D1055819
LAB Type	Ambulance
Facility Name	VILLAGE OF BRISTOL FIRE RESCUE DEPARTMENT
Street	19801 83RD ST
City	BRISTOL
State	WI
ZIP	53104
Phone	262 857-2711
CertificateType	4
CertificateEffectiveDate	6/28/2022
CertificateExpirationDate	6/27/2024
FacilityType	Waiver

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