CONSULTANTS LABORATORY OF WI, LLC NPI 1871636605

Clinical Medical Laboratory in Fond Du Lac, WI

NPI 1871636605 Organization Clinical Medical Laboratory CLIA Number 52D0968924 CLIA Certificate of Compliance

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 NameCONSULTANTS LABORATORY OF WI, LLC
Provider Location Address145 N MAIN ST FOND DU LAC, WI 54935
Provider Mailing Address430 E DIVISION ST FOND DU LAC, WI 54935
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?Yes
Enumeration Date02-14-2007
Last Update Date01-05-2009


Primary Taxonomy

Taxonomy Code291U00000X
ClassificationClinical Medical Laboratory
TypeLaboratories
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

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Mailing Address

CONSULTANTS LABORATORY OF WI, LLC
430 E DIVISION ST
FOND DU LAC, WI
ZIP 54935
Phone:



Authorized Official

Authorized Official NameMS. DEBORAH CHRISTIAN
Authorized Official TitlePATIENT ACCOUNTS SUPERVISOR
Authorized Official Phone(920) 926-5840

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 Number52D0968924
Facility TypeINDEPENDENT
Certificate TypeCertificate 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
000085260MEDICARE ID-TYPE UNSPECIFIED (04)WI
52D0968924OTHER (01)WI
32926400MEDICAID (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 Medicine145 N MAIN ST
FOND DU LAC, WI 54935
(920) 926-8492
1346222023 LEWIS A SIERRA MD
Individual
Internal Medicine145 N MAIN ST
FOND DU LAC, WI 54935
(920) 926-8492
1831175546 THOMAS J CARLSON MD
Individual
Surgery145 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
1780860460MRS. DENISE MARGARET KAMINSKY RPH
Individual
Pharmacist145 N MAIN ST
FOND DU LAC, WI 54935
(920) 921-4660
1669658258DR. KEVIN JOSEPH FESSLER PHARM.D.
Individual
Pharmacist145 N MAIN ST AGNESIAN PHARMACY
FOND DU LAC, WI 54935
(920) 926-4660
1720339997 MONICA J BRAUN NP
Individual
Nurse Practitioner145 N MAIN ST
FOND DU LAC, WI 54935
(920) 926-8492
1972780096MR. DAVID ALLEN KRUEGER DPH
Individual
Pharmacist145 N MAIN ST
FOND DU LAC, WI 54935
(920) 926-4660
1740614197DR. SHAUN STEPHENS PHARMD
Individual
Pharmacist145 N MAIN ST
FOND DU LAC, WI 54935
(920) 926-4660
1497096754 MORGAN LEIGH BERNARD PHARM.D.
Individual
Pharmacist145 N MAIN ST
FOND DU LAC, WI 54935
(920) 926-4660
1124019898 WILLIAM J BRUSKY MD
Individual
Family Medicine145 N MAIN ST
FOND DU LAC, WI 54935
(920) 926-8492
1538150990 MICHAEL W BACHHUBER MD
Individual
Family Medicine145 N MAIN ST
FOND DU LAC, WI 54935
(920) 926-8492
1689760381DR. MICHAEL LYLE TJOELKER M.D.
Individual
Dermatology145 N MAIN ST
FOND DU LAC, WI 54935
(920) 926-8722
1598777419 THOMAS J LUETZOW M.D.
Individual
Family Medicine145 N MAIN ST
FOND DU LAC, WI 54935
(920) 926-8492
1104891746AGNESIAN HEALTHCARE ENTERPRISES LLC
Organization
Pharmacy (Community/Retail Pharmacy)145 N MAIN ST
FOND DU LAC, WI 54935
(920) 921-4660
1942759303DR. JOSEPH RICHARD DVORAK PHARMD
Individual
Pharmacist145 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 Assistant145 N MAIN ST
FOND DU LAC, WI 54935
(920) 926-8492
1689610735AGNESIAN HEALTHCARE INC
Organization
Durable Medical Equipment & Medical Supplies145 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 Program145 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.