52D2296781 CLIA NUMBER - IFAST LAB PROS

Laboratory Demographics

  • CLIA Code: 52D2296781
  • Facility Name: IFAST LAB PROS
  • Facility Address: 5215 N IRONWOOD RD SUITE 202 PMB 1045
    GLENDALE, WI
    ZIP 53217
  • Facility Phone: 833 423-4033
  • Facility Type: Mobile Laboratory
  • Facility Type: Waiver
  • Lab Director: KEME D. ALLEN
  • NPI Number: 1811753536
  • Taxonomy: 291U00000X - Clinical Medical Laboratory

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CLIA Record

Field Name Field Value
CLIA Number 52D2296781
LAB Type Mobile Laboratory
Facility Name IFAST LAB PROS
Street 5215 N IRONWOOD RD SUITE 202 PMB 1045
City GLENDALE
State WI
ZIP 53217
Phone 833 423-4033
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/5/2024
Certificate Expiration Date 1/4/2026
Facility Type Mobile Laboratory
Lab Director KEME D. ALLEN

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