23D0692555 CLIA NUMBER - UNIVERSITY OF MICHIGAN HEALTH - SPARROW ITHACA PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 23D0692555
  • Facility Name: UNIVERSITY OF MICHIGAN HEALTH - SPARROW ITHACA PRIMARY CARE
  • Facility Address: 114 NORTH MAIN STREET
    ITHACA, MI
    ZIP 48847
  • Facility Phone: 989 875-4166
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DAVID J. FREESTONE
  • NPI Number: 1770553547
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 23D0692555
LAB Type Physician Office
Facility Name UNIVERSITY OF MICHIGAN HEALTH - SPARROW ITHACA PRIMARY CARE
Street 114 NORTH MAIN STREET
City ITHACA
State MI
ZIP 48847
Phone 989 875-4166
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/23/2023
Certificate Expiration Date 10/22/2025
Facility Type Physician Office
Lab Director DAVID J. FREESTONE

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