52D2008400 CLIA NUMBER - ASCENSION MEDICAL GROUP- FOX VALLEY WISCONSIN INC D/B/A ASCENSION MEDICAL GROUP

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Laboratory Demographics

CLIA Number: 52D2008400

Facility Name: ASCENSION MEDICAL GROUP- FOX VALLEY WISCONSIN INC D/B/A ASCENSION MEDICAL GROUP

Facility Address:
1550 MIDWAY PL
MENASHA, WI
ZIP 54952
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Facility Phone Number: 920 831-1700

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1154478469

Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies
A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.

CLIA Record

Field Name	Field Value
CLIA Number	52D2008400
LAB Type	Physician Office
Facility Name	ASCENSION MEDICAL GROUP- FOX VALLEY WISCONSIN INC D/B/A ASCENSION MEDICAL GROUP
Street	1550 MIDWAY PL
City	MENASHA
State	WI
ZIP	54952
Phone	920 831-1700
CertificateType	4
CertificateEffectiveDate	6/10/2022
CertificateExpirationDate	6/9/2024
FacilityType	Waiver

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