23D0377514 CLIA NUMBER - SAINT JOSEPH PEDIATRICS PLC

Laboratory Demographics

  • CLIA Code: 23D0377514
  • Facility Name: SAINT JOSEPH PEDIATRICS PLC
  • Facility Address: 3800 HOLLYWOOD ROAD #102
    SAINT JOSEPH, MI
    ZIP 49085
  • Facility Phone: 616 428-2727
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: MUKUND R. SHAH
  • NPI Number: 1669937926
  • Taxonomy: 152WV0400X - Optometrist

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CLIA Record

Field Name Field Value
CLIA Number 23D0377514
LAB Type Physician Office
Facility Name SAINT JOSEPH PEDIATRICS PLC
Street 3800 HOLLYWOOD ROAD #102
City SAINT JOSEPH
State MI
ZIP 49085
Phone 616 428-2727
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 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director MUKUND R. SHAH

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