23D0364135 CLIA NUMBER - PORT HURON FAMILY CARE

Laboratory Demographics

CLIA Number: 23D0364135

Facility Name: PORT HURON FAMILY CARE

Facility Address:
1979 HOLLAND AVENUE
PORT HURON, MI
ZIP 48060
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Facility Phone Number: 810 982-1200

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1518118470

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	23D0364135
LAB Type	Physician Office
Facility Name	PORT HURON FAMILY CARE
Street	1979 HOLLAND AVENUE
City	PORT HURON
State	MI
ZIP	48060
Phone	810 982-1200
CertificateType	4
CertificateEffectiveDate	2/8/2024
CertificateExpirationDate	2/7/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024