52D2310009 CLIA NUMBER - UPPER MISSISSIPPI SURGERY CENTER

Laboratory Demographics

  • CLIA Code: 52D2310009
  • Facility Name: UPPER MISSISSIPPI SURGERY CENTER
  • Facility Address: 454 BADGER ROAD
    HAZEL GREEN, WI
    ZIP 53811
  • Facility Phone: 608 473-1700
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: SUSAN M. GOURLEY
  • NPI Number: 1952153991
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 52D2310009
LAB Type Ambulatory Surgery Center
Facility Name UPPER MISSISSIPPI SURGERY CENTER
Street 454 BADGER ROAD
City HAZEL GREEN
State WI
ZIP 53811
Phone 608 473-1700
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/26/2024
Certificate Expiration Date 8/25/2026
Facility Type Ambulatory Surgery Center
Lab Director SUSAN M. GOURLEY

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