52D2123814 CLIA NUMBER - AURORA MEDICAL CENTER SHEBOYGAN COUNTY

Laboratory Demographics

CLIA Number: 52D2123814

Facility Name: AURORA MEDICAL CENTER SHEBOYGAN COUNTY

Facility Address:
1221 N 26TH STREET
SHEBOYGAN, WI
ZIP 53081
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Facility Phone Number: 920 451-7894

Facility Type: Other - OP BEHAVIORAL HEALTH PROG

Certificate Type: Waiver

NPI Number: 1174670244

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	52D2123814
LAB Type	Other - OP BEHAVIORAL HEALTH PROG
Facility Name	AURORA MEDICAL CENTER SHEBOYGAN COUNTY
Street	1221 N 26TH STREET
City	SHEBOYGAN
State	WI
ZIP	53081
Phone	920 451-7894
CertificateType	4
CertificateEffectiveDate	1/4/2023
CertificateExpirationDate	1/3/2025
FacilityType	Waiver

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