23D0381932 CLIA NUMBER - LAKE SUPERIOR STATE UNIVERSITY HEALTH CARE CENTER

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Laboratory Demographics

CLIA Number: 23D0381932

Facility Name: LAKE SUPERIOR STATE UNIVERSITY HEALTH CARE CENTER

Facility Address:
621 EASTERDAY AVENUE
SAULT SAINTE MARIE, MI
ZIP 49783
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Facility Phone Number: 906 635-2110

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1467454199

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name	Field Value
CLIA Number	23D0381932
LAB Type	Physician Office
Facility Name	LAKE SUPERIOR STATE UNIVERSITY HEALTH CARE CENTER
Street	621 EASTERDAY AVENUE
City	SAULT SAINTE MARIE
State	MI
ZIP	49783
Phone	906 635-2110
CertificateType	4
CertificateEffectiveDate	1/12/2024
CertificateExpirationDate	1/11/2026
FacilityType	Waiver

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