52D1090159 CLIA NUMBER - LAKE COUNTRY ENDOSCOPY CENTER

Laboratory Demographics

  • CLIA Code: 52D1090159
  • Facility Name: LAKE COUNTRY ENDOSCOPY CENTER
  • Facility Address: 1185 CORPORATE CENTER DR STE 125
    OCONOMOWOC, WI
    ZIP 53066
  • Facility Phone: 414 266-9209
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: DR. JAMES T. KWIATT
  • NPI Number: 1184612749
  • Taxonomy: 183500000X - Pharmacist

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CLIA Record

Field Name Field Value
CLIA Number 52D1090159
LAB Type Ambulatory Surgery Center
Facility Name LAKE COUNTRY ENDOSCOPY CENTER
Street 1185 CORPORATE CENTER DR STE 125
City OCONOMOWOC
State WI
ZIP 53066
Phone 414 266-9209
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/3/2024
Certificate Expiration Date 10/2/2026
Facility Type Ambulatory Surgery Center
Lab Director DR. JAMES T. KWIATT

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