52D2147494 CLIA NUMBER - FORT ATKINSON FD RESCUE SQUAD

Laboratory Demographics

  • CLIA Code: 52D2147494
  • Facility Name: FORT ATKINSON FD RESCUE SQUAD
  • Facility Address: 124 MILWAUKEE AVENUE WEST
    FORT ATKINSON, WI
    ZIP 53538
  • Facility Phone: 920 563-7795
  • Facility Type: Ambulance
  • Facility Type: Waiver
  • Lab Director: MR. MICHAEL LAWRENCE
  • NPI Number: 1972093706
  • Taxonomy: 3416L0300X - Ambulance

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CLIA Record

Field Name Field Value
CLIA Number 52D2147494
LAB Type Ambulance
Facility Name FORT ATKINSON FD RESCUE SQUAD
Street 124 MILWAUKEE AVENUE WEST
City FORT ATKINSON
State WI
ZIP 53538
Phone 920 563-7795
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/20/2024
Certificate Expiration Date 4/19/2026
Facility Type Ambulance
Lab Director MR. MICHAEL LAWRENCE

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