52D2178966 CLIA NUMBER - ST ANN CENTER FOR INTERGENERATIONAL CARE BUCYRUS CAMPUS

Laboratory Demographics

  • CLIA Code: 52D2178966
  • Facility Name: ST ANN CENTER FOR INTERGENERATIONAL CARE BUCYRUS CAMPUS
  • Facility Address: 2540 W NORTH AVE
    MILWAUKEE, WI
    ZIP 53205
  • Facility Phone: 414 210-2435
  • Facility Type: Community Clinic
  • Facility Type: Microscopy
  • Lab Director: MS. NICOLE BERG-JOHNSON
  • NPI Number: 1841667466
  • Taxonomy: 251K00000X - Public Health or Welfare

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CLIA Record

Field Name Field Value
CLIA Number 52D2178966
LAB Type Community Clinic
Facility Name ST ANN CENTER FOR INTERGENERATIONAL CARE BUCYRUS CAMPUS
Street 2540 W NORTH AVE
City MILWAUKEE
State WI
ZIP 53205
Phone 414 210-2435
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 2/12/2024
Certificate Expiration Date 2/11/2026
Facility Type Community Clinic
Lab Director MS. NICOLE BERG-JOHNSON

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