Consultants Laboratory of Wisconsin, LLC
Organization Active NPI Clinical Medical Laboratory · Beaver Dam, WI
NPI 1336739101 · NPPES record last updated Dec 16, 2022
Key facts
- NPI
- 1336739101
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Medical Laboratory 291U00000X
- Legal business name
- CONSULTANTS LABORATORY OF WISCONSIN, LLC
- Practice address
- 130 Corporate Dr
Beaver Dam, WI 53916-3116 - Phone
- (920) 926-5840
- NPI assigned
- Jan 25, 2021
- Organization subpart
- No
Authorized official
- Name
- Deborah Lynn Christian
- Title
- Supervisor, Rev Cycle Patient Accts
- Phone
- (920) 926-5840
Other NPIs on the same Medicare enrollment 14
Corporate family (same tax ID) 12
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 52D0394045 | Consultants Laboratory of Wi, LLC | Compliance | Jun 6, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040311001446 | WI | Part B Supplier - Independent Clinical Laboratory | 8628967205 |
19 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Fond Du Lac, WI; Waupun, WI; Ripon, WI; North Fond Du Lac, WI; Mount Calvary, WI; Mayville, WI; Fox Lake, WI; Markesan, WI… |
National Provider Directory
- Tax ID family
- Consultants Laboratory
Locations
130 Corporate Dr
Beaver Dam, WI 53916
Phone (920) 877-3102
601 E Clark St
Brandon, WI 53919
Phone (920) 346-8300
N6663 Rolling Meadows Dr
Fond du Lac, WI 54937
Phone (920) 907-3970
377 N Rolling Meadows Dr
Fond du Lac, WI 54937
Phone (920) 907-0453
702 Eisenhower Dr
Kimberly, WI 54136
Phone (920) 730-1155
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Medical Laboratory | 291U00000X | Yes |
Addresses
Primary practice location
130 Corporate Dr
Beaver Dam, WI 53916-3116
Mailing address
430 E Division St
Fond Du Lac, WI 54935-4560
Phone (920) 926-5840
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 52D0394045 | Other | WI | CLIA |
Other names
- SSM Health Laboratories
Other providers in Beaver Dam, WI
- Richard Clutson
- Edward F Cody
- Robert A Coe
- Community Pediatrics SC
- Daniel Conard
- Debra Lynn Conway
- Mischa Renee Cordle
- Laura Ellen Correa
- Amy Lynn Creighton
- Tracy L Crombie
All providers in Beaver Dam, WI · Clinical Medical Laboratory in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 16, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.