23D0379117 CLIA NUMBER - TRINITY HEALTH MEDICAL GROUP - PRIMARY CARE - SPARTA

Laboratory Demographics

CLIA Number: 23D0379117

Facility Name: TRINITY HEALTH MEDICAL GROUP - PRIMARY CARE - SPARTA

Facility Address:
475 S STATE STREET
SPARTA, MI
ZIP 49345
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Facility Phone Number: 616 685-1300

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1245769744

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	23D0379117
LAB Type	Physician Office
Facility Name	TRINITY HEALTH MEDICAL GROUP - PRIMARY CARE - SPARTA
Street	475 S STATE STREET
City	SPARTA
State	MI
ZIP	49345
Phone	616 685-1300
CertificateType	3
CertificateEffectiveDate	1/19/2024
CertificateExpirationDate	1/18/2026
FacilityType	PPMP

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