52D2311292 CLIA NUMBER - PROACTIVE MD FAMILY HEALTH CENTER

Laboratory Demographics

  • CLIA Code: 52D2311292
  • Facility Name: PROACTIVE MD FAMILY HEALTH CENTER
  • Facility Address: 20611 WATERTOWN ROAD SUITE C
    WAUKESHA, WI
    ZIP 53186
  • Facility Phone: 864 501-0751
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: DR. JASON J. CRUMPLER
  • NPI Number: 1275179541
  • Taxonomy: 261QP2300X - Clinic/Center

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 52D2311292
LAB Type Practitioner Other
Facility Name PROACTIVE MD FAMILY HEALTH CENTER
Street 20611 WATERTOWN ROAD SUITE C
City WAUKESHA
State WI
ZIP 53186
Phone 864 501-0751
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/19/2024
Certificate Expiration Date 9/18/2026
Facility Type Practitioner Other
Lab Director DR. JASON J. CRUMPLER

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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