52D2089531 CLIA NUMBER - PREMISE HEALTH OF WISCONISN MEDICAL CENTER, SC

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Laboratory Demographics

CLIA Number: 52D2089531

Facility Name: PREMISE HEALTH OF WISCONISN MEDICAL CENTER, SC

Facility Address:
292 OHIO ST
OSHKOSH, WI
ZIP 54902
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Facility Phone Number: 920 267-5332

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1235890435

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	52D2089531
LAB Type	Physician Office
Facility Name	PREMISE HEALTH OF WISCONISN MEDICAL CENTER, SC
Street	292 OHIO ST
City	OSHKOSH
State	WI
ZIP	54902
Phone	920 267-5332
CertificateType	4
CertificateEffectiveDate	1/5/2023
CertificateExpirationDate	1/4/2025
FacilityType	Waiver

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