52D2307069 CLIA NUMBER - PESHTIGO (CITY OF) FIRE RESCUE DEPT

Laboratory Demographics

  • CLIA Code: 52D2307069
  • Facility Name: PESHTIGO (CITY OF) FIRE RESCUE DEPT
  • Facility Address: 331 FRENCH STREET
    PESHTIGO, WI
    ZIP 54157
  • Facility Phone: 715 582-3041
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: CHARLES P. GARDON
  • NPI Number: 1932388477
  • Taxonomy: 251300000X - Local Education Agency (LEA)

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CLIA Record

Field Name Field Value
CLIA Number 52D2307069
LAB Type Practitioner Other
Facility Name PESHTIGO (CITY OF) FIRE RESCUE DEPT
Street 331 FRENCH STREET
City PESHTIGO
State WI
ZIP 54157
Phone 715 582-3041
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/1/2024
Certificate Expiration Date 6/30/2026
Facility Type Practitioner Other
Lab Director CHARLES P. GARDON

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