23D0036720 CLIA NUMBER - WELLNESS PLAN,THE MEDICAL CENTERS - EA

Laboratory Demographics

  • CLIA Code: 23D0036720
  • Facility Name: WELLNESS PLAN,THE MEDICAL CENTERS - EA
  • Facility Address: 4909 E OUTER DRIVE
    DETROIT, MI
    ZIP 48234
  • Facility Phone: 313 366-2000
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Microscopy
  • Lab Director: TIFFANY L. SANFORD
  • NPI Number: 1093180044
  • Taxonomy: 261QU0200X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 23D0036720
LAB Type Federally Qualified Health Center
Facility Name WELLNESS PLAN,THE MEDICAL CENTERS - EA
Street 4909 E OUTER DRIVE
City DETROIT
State MI
ZIP 48234
Phone 313 366-2000
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 6/7/2024
Certificate Expiration Date 6/6/2026
Facility Type Federally Qualified Health Center
Lab Director TIFFANY L. SANFORD

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This page was last updated on: 9/29/2025