23D0375784 CLIA NUMBER - COREWELL HEALTH PENNOCK HOSPITAL FAMILY MEDICINE - LAKE ODESSA

Laboratory Demographics

  • CLIA Code: 23D0375784
  • Facility Name: COREWELL HEALTH PENNOCK HOSPITAL FAMILY MEDICINE - LAKE ODESSA
  • Facility Address: 4294 LAUREL DRIVE
    LAKE ODESSA, MI
    ZIP 48849
  • Facility Phone: 616 374-7660
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: LAURIE BRAKER
  • NPI Number: 1962889584
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 23D0375784
LAB Type Rural Health Clinic
Facility Name COREWELL HEALTH PENNOCK HOSPITAL FAMILY MEDICINE - LAKE ODESSA
Street 4294 LAUREL DRIVE
City LAKE ODESSA
State MI
ZIP 48849
Phone 616 374-7660
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/10/2024
Certificate Expiration Date 8/9/2026
Facility Type Rural Health Clinic
Lab Director LAURIE BRAKER

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