52D1056543 CLIA NUMBER - SURGERY CENTER OF WISCONSIN RAPIDS

Laboratory Demographics

CLIA Number: 52D1056543

Facility Name: SURGERY CENTER OF WISCONSIN RAPIDS

Facility Address:
140 24TH ST SOUTH
WISCONSIN RAPIDS, WI
ZIP 54494
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Facility Phone Number: 715 424-1881

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1194813840

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	52D1056543
LAB Type	Ambulatory Surgery Center
Facility Name	SURGERY CENTER OF WISCONSIN RAPIDS
Street	140 24TH ST SOUTH
City	WISCONSIN RAPIDS
State	WI
ZIP	54494
Phone	715 424-1881
CertificateType	4
CertificateEffectiveDate	7/19/2022
CertificateExpirationDate	7/18/2024
FacilityType	Waiver

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