CONSULTANTS LABORATORY OF WI, LLC NPI 1871636605
Clinical Medical Laboratory in Fond Du Lac, WI
About CONSULTANTS LABORATORY OF WI, LLC
Consultants Laboratory Of Wi, Llc is a provider established in Fond Du Lac, Wisconsin specializing in clinical medical laboratory. The NPI number of Consultants Laboratory Of Wi, Llc is 1871636605 and was assigned on February 2007. The practitioner's primary taxonomy code is 291U00000X. The provider is registered as an organization and their NPI record was last updated 12 years ago. The authorized official of this NPI record is Ms. Deborah Christian (Patient Accounts Supervisor)
The CLIA number of Consultants Laboratory Of Wi, Llc is 52D0968924 registered as a "independent" facility with a CLIA Certificate of Compliance. This CLIA certificate is issued to Consultants Laboratory Of Wi, Llc after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements. This type of certificate is issued to laboratories that perform nonwaived (moderate and/or high complexity) testing.
| NPI | 1871636605 |
| Provider Name | CONSULTANTS LABORATORY OF WI, LLC |
| Provider Location Address | 145 N MAIN ST FOND DU LAC, WI 54935 |
| Provider Mailing Address | 430 E DIVISION ST FOND DU LAC, WI 54935 |
| NPI Entity Type | Organization |
| Is Sole Proprietor? | N/A |
| Is Organization Subpart? | Yes |
| Enumeration Date | 02-14-2007 |
| Last Update Date | 01-05-2009 |
Primary Taxonomy
| Taxonomy Code | 291U00000X |
| Classification | Clinical Medical Laboratory |
| Type | Laboratories |
| Taxonomy Description | (1) A clinical laboratory is a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, human beings. These examinations also include procedures to determine, measure, or otherwise describe the presence or absence of various substances or organisms in the body. Facilities only collecting or preparing specimens (or both) or only serving as a mailing service and not performing testing are not considered clinical laboratories. (2) Any facility that examines materials from the human body for purposes of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of, the health of human beings. Typical divisions of a clinical laboratory include hematology, cytology, bacteriology, histology, biochemistry, medical toxicology, and serology. |
Business Address
CONSULTANTS LABORATORY OF WI, LLC
145 N MAIN ST
FOND DU LAC, WI
ZIP 54935
Phone: (920) 926-8653
Mailing Address
CONSULTANTS LABORATORY OF WI, LLC
430 E DIVISION ST
FOND DU LAC, WI
ZIP 54935
Phone:
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for the NPI number 1871636605 is:
| CLIA Number | 52D0968924 |
| Facility Type | INDEPENDENT |
| Certificate Type | Certificate of Compliance |
Additional Identifiers
Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State |
|---|---|---|
| 000085260 | MEDICARE ID-TYPE UNSPECIFIED (04) | WI |
| 52D0968924 | OTHER (01) | WI |
| 32926400 | MEDICAID (05) | WI |
Other Providers at the same location
The following 20 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1518949882 | DAVID P MATTHEWS MD Individual | Emergency Medicine | 145 N MAIN ST FOND DU LAC, WI 54935 (920) 926-8492 |
| 1346222023 | LEWIS A SIERRA MD Individual | Internal Medicine | 145 N MAIN ST FOND DU LAC, WI 54935 (920) 926-8492 |
| 1831175546 | THOMAS J CARLSON MD Individual | Surgery | 145 N MAIN ST FOND DU LAC, WI 54935 (920) 926-8492 |
| 1518004480 | DOROTHY A KEENAN NP Individual | Nurse Practitioner (Family) | 145 N MAIN ST FOND DU LAC, WI 54935 (920) 926-8492 |
| 1780860460 | MRS. DENISE MARGARET KAMINSKY RPH Individual | Pharmacist | 145 N MAIN ST FOND DU LAC, WI 54935 (920) 921-4660 |
| 1669658258 | DR. KEVIN JOSEPH FESSLER PHARM.D. Individual | Pharmacist | 145 N MAIN ST AGNESIAN PHARMACY FOND DU LAC, WI 54935 (920) 926-4660 |
| 1720339997 | MONICA J BRAUN NP Individual | Nurse Practitioner | 145 N MAIN ST FOND DU LAC, WI 54935 (920) 926-8492 |
| 1972780096 | MR. DAVID ALLEN KRUEGER DPH Individual | Pharmacist | 145 N MAIN ST FOND DU LAC, WI 54935 (920) 926-4660 |
| 1740614197 | DR. SHAUN STEPHENS PHARMD Individual | Pharmacist | 145 N MAIN ST FOND DU LAC, WI 54935 (920) 926-4660 |
| 1497096754 | MORGAN LEIGH BERNARD PHARM.D. Individual | Pharmacist | 145 N MAIN ST FOND DU LAC, WI 54935 (920) 926-4660 |
| 1124019898 | WILLIAM J BRUSKY MD Individual | Family Medicine | 145 N MAIN ST FOND DU LAC, WI 54935 (920) 926-8492 |
| 1538150990 | MICHAEL W BACHHUBER MD Individual | Family Medicine | 145 N MAIN ST FOND DU LAC, WI 54935 (920) 926-8492 |
| 1689760381 | DR. MICHAEL LYLE TJOELKER M.D. Individual | Dermatology | 145 N MAIN ST FOND DU LAC, WI 54935 (920) 926-8722 |
| 1598777419 | THOMAS J LUETZOW M.D. Individual | Family Medicine | 145 N MAIN ST FOND DU LAC, WI 54935 (920) 926-8492 |
| 1104891746 | AGNESIAN HEALTHCARE ENTERPRISES LLC Organization | Pharmacy (Community/Retail Pharmacy) | 145 N MAIN ST FOND DU LAC, WI 54935 (920) 921-4660 |
| 1942759303 | DR. JOSEPH RICHARD DVORAK PHARMD Individual | Pharmacist | 145 N MAIN ST FOND DU LAC, WI 54935 (920) 926-4660 |
| 1770089526 | STEVEN REMBALSKI DNP Individual | Nurse Practitioner (Family) | 145 N MAIN ST FOND DU LAC, WI 54935 (920) 926-8492 |
| 1063884450 | ALEXANDER ENGEL PHYSICIAN ASSISTANT Individual | Physician Assistant | 145 N MAIN ST FOND DU LAC, WI 54935 (920) 926-8492 |
| 1689610735 | AGNESIAN HEALTHCARE INC Organization | Durable Medical Equipment & Medical Supplies | 145 N MAIN ST FOND DU LAC, WI 54935 (920) 926-8492 |
| 1902451388 | RITA SHARMA MA, MSW Individual | Student in an Organized Health Care Education/Training Program | 145 N MAIN ST FOND DU LAC, WI 54935 (920) 926-8903 |
NPI Footnotes
What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.
Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.
Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.
Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.
Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date
The date that a NPI record was last updated or changed.
Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.