52D2264111 CLIA NUMBER - WAUSHARA COUNTY JAIL

Laboratory Demographics

  • CLIA Code: 52D2264111
  • Facility Name: WAUSHARA COUNTY JAIL
  • Facility Address: 430 E DIVISION ST
    WAUTOMA, WI
    ZIP 54982
  • Facility Phone: 423 206-2002
  • Facility Type: Other - JAIL MEDICAL UNIT
  • Facility Type: Waiver
  • Lab Director: TONYA POWELL
  • NPI Number: 1790737443
  • Taxonomy: 343900000X - Non-emergency Medical Transport (VAN)

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CLIA Record

Field Name Field Value
CLIA Number 52D2264111
LAB Type Other - JAIL MEDICAL UNIT
Facility Name WAUSHARA COUNTY JAIL
Street 430 E DIVISION ST
City WAUTOMA
State WI
ZIP 54982
Phone 423 206-2002
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/11/2024
Certificate Expiration Date 7/10/2026
Facility Type Other - JAIL MEDICAL UNIT
Lab Director TONYA POWELL

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