Organization
BAYSHORE CLINICAL LABORATORIES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEN JAGLINSKI MT (LAB MANAGER)
(414) 368-1999
Entity
Organization
Contact information
Practice address
9055 N 51ST ST, BROWN DEER, WI 53223-2477
(414) 368-1999
Mailing address
9055 N 51ST ST, BROWN DEER, WI 53223-2477
(414) 368-1999
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
52D2053574
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
52D2053574
CMS CLIA
WI
Enumeration date
01/07/2016
Last updated
01/07/2016
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