52D2241261 CLIA NUMBER - OZAUKEE COUNTY JAIL

Laboratory Demographics

CLIA Number: 52D2241261

Facility Name: OZAUKEE COUNTY JAIL

Facility Address:
1201 S SPRING ST
PORT WASHINGTON, WI
ZIP 53074
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Facility Phone Number: 262 284-7172

Facility Type: Prison

Certificate Type: Waiver

NPI Number: 1396016028

Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies
A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.

CLIA Record

Field Name	Field Value
CLIA Number	52D2241261
LAB Type	Prison
Facility Name	OZAUKEE COUNTY JAIL
Street	1201 S SPRING ST
City	PORT WASHINGTON
State	WI
ZIP	53074
Phone	262 284-7172
CertificateType	4
CertificateEffectiveDate	10/26/2023
CertificateExpirationDate	10/25/2025
FacilityType	Waiver

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