Provider Demographics
NPI:1891778346
Name:CONSULTANTS LABORATORY OF WISCONSIN, LLC
Entity Type:Organization
Organization Name:CONSULTANTS LABORATORY OF WISCONSIN, LLC
Other - Org Name:CONSULTANTS LABORATORY OF WISCONSIN, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PATIENT ACCOUNTS SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CHRISTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-926-5840
Mailing Address - Street 1:430 E DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-4560
Mailing Address - Country:US
Mailing Address - Phone:920-926-5840
Mailing Address - Fax:920-926-8900
Practice Address - Street 1:430 E DIVISION ST
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-4560
Practice Address - Country:US
Practice Address - Phone:920-926-5840
Practice Address - Fax:920-926-8900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-29
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32906800Medicaid
WI32928400Medicaid
WI32927800Medicaid
WI32939300Medicaid
WI32914700Medicaid
WI32926400Medicaid
WI32935000Medicaid
WI32935100Medicaid
WI32935200Medicaid
WI32935300Medicaid
WI52D0397685OtherCLIA