52D2034137 CLIA NUMBER - BELLIN HEALTH EMPLOYER CLINICS

Laboratory Demographics

  • CLIA Code: 52D2034137
  • Facility Name: BELLIN HEALTH EMPLOYER CLINICS
  • Facility Address: 1630 COMMANCHE AVE
    GREEN BAY, WI
    ZIP 54313
  • Facility Phone: 920 430-4553
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. LOREN C. FUGLESTAD
  • NPI Number: 1427033919
  • Taxonomy: 2255A2300X - Specialist/Technologist

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CLIA Record

Field Name Field Value
CLIA Number 52D2034137
LAB Type Physician Office
Facility Name BELLIN HEALTH EMPLOYER CLINICS
Street 1630 COMMANCHE AVE
City GREEN BAY
State WI
ZIP 54313
Phone 920 430-4553
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/16/2023
Certificate Expiration Date 12/15/2025
Facility Type Physician Office
Lab Director DR. LOREN C. FUGLESTAD

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