52D2308830 CLIA NUMBER - SSM HEALTH DAVIS DUEHR DEAN (DMG - PORTAGE)

Laboratory Demographics

  • CLIA Code: 52D2308830
  • Facility Name: SSM HEALTH DAVIS DUEHR DEAN (DMG - PORTAGE)
  • Facility Address: 2825 HUNTERS TRAIL
    PORTAGE, WI
    ZIP 53901
  • Facility Phone: 608 260-6557
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. STEPHEN M. BOORSTEIN
  • NPI Number: 1760593545
  • Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies

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CLIA Record

Field Name Field Value
CLIA Number 52D2308830
LAB Type Physician Office
Facility Name SSM HEALTH DAVIS DUEHR DEAN (DMG - PORTAGE)
Street 2825 HUNTERS TRAIL
City PORTAGE
State WI
ZIP 53901
Phone 608 260-6557
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/5/2024
Certificate Expiration Date 8/4/2026
Facility Type Physician Office
Lab Director DR. STEPHEN M. BOORSTEIN

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