NPIMap

Organization Active NPI

Consultants Laboratory of Wisconsin, LLC

  • Clinical Medical Laboratory
  • Fox Lake, WI
National Provider Identifier
1497897565
Registry record updated Dec 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
CONSULTANTS LABORATORY OF WISCONSIN, LLC
Practice address
703 W State St
Fox Lake, WI 53933-9550
Phone
(920) 926-5840
NPI assigned
Feb 13, 2007
Last updated
Dec 16, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
CONSULTANTS LABORATORY OF WISCONSIN, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 16, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Deborah Christian
Title
Patient Accounts Supervisor
Phone
(920) 926-5840

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X NU Primary

Addresses

Primary practice location

703 W State St
Fox Lake, WI 53933-9550

Mailing address

430 E Division St
Fond Du Lac, WI 54935-4560

Other identifiers 2

IdentifierTypeStateIssuer
32928500MedicaidWI
52D0990643OtherWICLIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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…

Other NPIs on the same Medicare enrollment 14

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 14

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
52D0990643Consultants Lab of Wisconsin, LLC703 W State St, Fox Lake, WI 53933Certificate of waiverFeb 4, 2028

National Provider Directory

National Provider Directory
Tax ID family
Consultant Lab Wi LLC13 organizations share this tax ID, including this one
Part of
Consultant Lab Wi LLC

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671148800000",
    "number": "1497897565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "430 E DIVISION ST",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549354560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "703 W STATE ST",
            "city": "FOX LAKE",
            "state": "WI",
            "postal_code": "539339550",
            "telephone_number": "920-926-5840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONSULTANTS LABORATORY OF WISCONSIN, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CONSULTANTS LABORATORY OF WISCONSIN, LLC",
        "enumeration_date": "2007-02-13",
        "last_updated": "2022-12-16",
        "certification_date": "2022-12-16",
        "status": "A",
        "authorized_official_last_name": "CHRISTIAN",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_title_or_position": "PATIENT ACCOUNTS SUPERVISOR",
        "authorized_official_telephone_number": "920-926-5840",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32928500",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "52D0990643",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fox Lake, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.