53D2047894 CLIA NUMBER - CONVERSE COUNTY PUBLIC HEALTH

Laboratory Demographics

  • CLIA Code: 53D2047894
  • Facility Name: CONVERSE COUNTY PUBLIC HEALTH
  • Facility Address: 255 N RUSSELL AVE
    DOUGLAS, WY
    ZIP 82633
  • Facility Phone: 307 358-2536
  • Facility Type: Public Health Laboratories
  • Facility Type: Microscopy
  • Lab Director: DR. HANSULD TIA
  • NPI Number: 1033263447
  • Taxonomy: 3416L0300X - Ambulance

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CLIA Record

Field Name Field Value
CLIA Number 53D2047894
LAB Type Public Health Laboratories
Facility Name CONVERSE COUNTY PUBLIC HEALTH
Street 255 N RUSSELL AVE
City DOUGLAS
State WY
ZIP 82633
Phone 307 358-2536
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 10/4/2024
Certificate Expiration Date 10/3/2026
Facility Type Public Health Laboratories
Lab Director DR. HANSULD TIA

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