52D2181359 CLIA NUMBER - THEDACARE FAMILY MEDICINE GATEWAY

Laboratory Demographics

CLIA Number: 52D2181359

Facility Name: THEDACARE FAMILY MEDICINE GATEWAY

Facility Address:
3925 N GATEWAY DRIVE
APPLETON, WI
ZIP 54913
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Facility Phone Number: 920 454-8444

Facility Type: Physician Office

Certificate Type: Certificate of Compliance

NPI Number: 1780733840

Taxonomy: 261QM1200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	52D2181359
LAB Type	Physician Office
Facility Name	THEDACARE FAMILY MEDICINE GATEWAY
Street	3925 N GATEWAY DRIVE
City	APPLETON
State	WI
ZIP	54913
Phone	920 454-8444
CertificateType	2
CertificateEffectiveDate	12/16/2023
CertificateExpirationDate	12/15/2025
FacilityType	Compliance

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