52D2264012 CLIA NUMBER - PEDIATRUST

Laboratory Demographics

  • CLIA Code: 52D2264012
  • Facility Name: PEDIATRUST
  • Facility Address: 4040 OJIBWA DR
    EAGLE RIVER, WI
    ZIP 54521
  • Facility Phone: 224 330-6300
  • Facility Type: Independent
  • Facility Type: Waiver
  • Lab Director: DR. JOSHUA D. LEVIN
  • NPI Number: 1982958013
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 52D2264012
LAB Type Independent
Facility Name PEDIATRUST
Street 4040 OJIBWA DR
City EAGLE RIVER
State WI
ZIP 54521
Phone 224 330-6300
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/8/2024
Certificate Expiration Date 7/7/2026
Facility Type Independent
Lab Director DR. JOSHUA D. LEVIN

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