23D0379553 CLIA NUMBER - GEORGETOWN MEDICAL CTR

Laboratory Demographics

CLIA Number: 23D0379553

Facility Name: GEORGETOWN MEDICAL CTR

Facility Address:
670 BALDWIN
JENISON, MI
ZIP 49428
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Facility Phone Number: 616 457-4610

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1427170414

Taxonomy: 208D00000X - General Practice
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

CLIA Record

Field Name	Field Value
CLIA Number	23D0379553
LAB Type	Physician Office
Facility Name	GEORGETOWN MEDICAL CTR
Street	670 BALDWIN
City	JENISON
State	MI
ZIP	49428
Phone	616 457-4610
CertificateType	4
CertificateEffectiveDate	1/3/2023
CertificateExpirationDate	1/2/2025
FacilityType	Waiver

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