52D1061920 CLIA NUMBER - ST CLARE MEMORIAL HOSPITAL SURING HEALTH CENTER

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Laboratory Demographics

CLIA Number: 52D1061920

Facility Name: ST CLARE MEMORIAL HOSPITAL SURING HEALTH CENTER

Facility Address:
913 E MAIN ST
SURING, WI
ZIP 54174
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Facility Phone Number: 920 842-1147

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1750412292

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	52D1061920
LAB Type	Physician Office
Facility Name	ST CLARE MEMORIAL HOSPITAL SURING HEALTH CENTER
Street	913 E MAIN ST
City	SURING
State	WI
ZIP	54174
Phone	920 842-1147
CertificateType	4
CertificateEffectiveDate	8/1/2023
CertificateExpirationDate	7/31/2025
FacilityType	Waiver

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