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52D2287176 CLIA NUMBER - PROHEALTH WAUKESHA MEMORIAL HOSPITAL, INC - INTERVENTIONAL PAIN MANAGEMENT SERVICES

Laboratory Demographics

CLIA Number: 52D2287176

Facility Name: PROHEALTH WAUKESHA MEMORIAL HOSPITAL, INC - INTERVENTIONAL PAIN MANAGEMENT SERVICES

Facility Address:
721 AMERICAN AVENUE, SUITE 108
WAUKESHA, WI
ZIP 53188
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Facility Phone Number: 262 928-7312

Facility Type: Hospital

Certificate Type: Waiver
NPI Number: 1194866962

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name Field Value
CLIA Number 52D2287176
LAB Type Hospital
Facility Name PROHEALTH WAUKESHA MEMORIAL HOSPITAL, INC - INTERVENTIONAL PAIN MANAGEMENT SERVICES
Street 721 AMERICAN AVENUE, SUITE 108
City WAUKESHA
State WI
ZIP 53188
Phone 262 928-7312
CertificateType 4
CertificateEffectiveDate 8/10/2023
CertificateExpirationDate 8/9/2025
FacilityType Waiver

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