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52D2232785 CLIA NUMBER - PREMISE HEALTH OF WISCONSIN MEDICAL, SC CAREHERE A PREMISE HEALTH COMPANY EHEALTH CENTER

Laboratory Demographics

CLIA Number: 52D2232785

Facility Name: PREMISE HEALTH OF WISCONSIN MEDICAL, SC CAREHERE A PREMISE HEALTH COMPANY EHEALTH CENTER

Facility Address:
16531 W NURSERY RD
HAYWARD, WI
ZIP 54843
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Facility Phone Number: 715 699-8019

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1942968953

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name Field Value
CLIA Number 52D2232785
LAB Type Physician Office
Facility Name PREMISE HEALTH OF WISCONSIN MEDICAL, SC CAREHERE A PREMISE HEALTH COMPANY EHEALTH CENTER
Street 16531 W NURSERY RD
City HAYWARD
State WI
ZIP 54843
Phone 715 699-8019
CertificateType 4
CertificateEffectiveDate 8/17/2023
CertificateExpirationDate 8/16/2025
FacilityType Waiver

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