52D2299697 CLIA NUMBER - QAM, INC DBA MANITOWOC COMPREHENSIVE TREATMENT CENTER

Laboratory Demographics

CLIA Number: 52D2299697

Facility Name: QAM, INC DBA MANITOWOC COMPREHENSIVE TREATMENT CENTER

Facility Address:
1100 SOUTH 30TH STREET, SUITE 220
MANITOWOC, WI
ZIP 54220
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Facility Phone Number: 920 458-6527

Facility Type: Comp. Outpatient Rehab Facility

Certificate Type: Waiver

NPI Number: 1700803541

Taxonomy: 207RN0300X - Internal Medicine
An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation.

CLIA Record

Field Name	Field Value
CLIA Number	52D2299697
LAB Type	Comp. Outpatient Rehab Facility
Facility Name	QAM, INC DBA MANITOWOC COMPREHENSIVE TREATMENT CENTER
Street	1100 SOUTH 30TH STREET, SUITE 220
City	MANITOWOC
State	WI
ZIP	54220
Phone	920 458-6527
CertificateType	4
CertificateEffectiveDate	2/26/2024
CertificateExpirationDate	2/25/2026
FacilityType	Waiver

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