23D0379159 CLIA NUMBER - RANDALL STREET MEDICAL PC

Laboratory Demographics

  • CLIA Code: 23D0379159
  • Facility Name: RANDALL STREET MEDICAL PC
  • Facility Address: 675 WEST RANDALL STREET
    COOPERSVILLE, MI
    ZIP 49404
  • Facility Phone: 616 837-9777
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: ROGER HOLMAN
  • NPI Number: 1598734584
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 23D0379159
LAB Type Physician Office
Facility Name RANDALL STREET MEDICAL PC
Street 675 WEST RANDALL STREET
City COOPERSVILLE
State MI
ZIP 49404
Phone 616 837-9777
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 3/4/2024
Certificate Expiration Date 3/3/2026
Facility Type Physician Office
Lab Director ROGER HOLMAN

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