52D2072379 CLIA NUMBER - EVERSIDE HEALTH, LLC - BEAVER DAM

Home > CLIA Lookup > 52D2072379

Laboratory Demographics

CLIA Number: 52D2072379

Facility Name: EVERSIDE HEALTH, LLC - BEAVER DAM

Facility Address:
215 CORPORATE DR STE A
BEAVER DAM, WI
ZIP 53916
Get Directions

Facility Phone Number: 920 210-3501

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1154877504

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name	Field Value
CLIA Number	52D2072379
LAB Type	Physician Office
Facility Name	EVERSIDE HEALTH, LLC - BEAVER DAM
Street	215 CORPORATE DR STE A
City	BEAVER DAM
State	WI
ZIP	53916
Phone	920 210-3501
CertificateType	4
CertificateEffectiveDate	11/29/2022
CertificateExpirationDate	11/28/2024
FacilityType	Waiver

Download Record

Export to text format icon Download this CLIA NUMBER record in Text format: Export

Export to text format icon Download this CLIA NUMBER record in Excel (CSV) format: Export

Export to text format icon Download this CLIA NUMBER record in XML format: Export

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