52D2102510 CLIA NUMBER - GREEN LAKE COUNTY DIALYSIS

Laboratory Demographics

  • CLIA Code: 52D2102510
  • Facility Name: GREEN LAKE COUNTY DIALYSIS
  • Facility Address: 432 OAK ST
    BERLIN, WI
    ZIP 54923
  • Facility Phone: 920 361-1177
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: DR. EDWARD LAKE
  • NPI Number: 1235513912
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 52D2102510
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name GREEN LAKE COUNTY DIALYSIS
Street 432 OAK ST
City BERLIN
State WI
ZIP 54923
Phone 920 361-1177
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/24/2025
Certificate Expiration Date 9/23/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director DR. EDWARD LAKE

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