52D2078114 CLIA NUMBER - WISCONSIN SPECIALTY SURGERY CENTER, LLC

Laboratory Demographics

  • CLIA Code: 52D2078114
  • Facility Name: WISCONSIN SPECIALTY SURGERY CENTER, LLC
  • Facility Address: 7401 104TH AVE, STE 100
    KENOSHA, WI
    ZIP 53142
  • Facility Phone: 262 939-0237
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: MS. KRISTY MINATTO
  • NPI Number: 1568821841
  • Taxonomy: 363LF0000X - Nurse Practitioner

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 52D2078114
LAB Type Ambulatory Surgery Center
Facility Name WISCONSIN SPECIALTY SURGERY CENTER, LLC
Street 7401 104TH AVE, STE 100
City KENOSHA
State WI
ZIP 53142
Phone 262 939-0237
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/22/2024
Certificate Expiration Date 5/21/2026
Facility Type Ambulatory Surgery Center
Lab Director MS. KRISTY MINATTO

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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