23D0692909 CLIA NUMBER - COREWELL HEALTH PRIMARY CARE - ROYALTON

Laboratory Demographics

CLIA Number: 23D0692909

Facility Name: COREWELL HEALTH PRIMARY CARE - ROYALTON

Facility Address:
3950 HOLLYWOOD ROAD SUITE 270
SAINT JOSEPH, MI
ZIP 49085
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Facility Phone Number: 269 982-4310

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1487751277

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	23D0692909
LAB Type	Physician Office
Facility Name	COREWELL HEALTH PRIMARY CARE - ROYALTON
Street	3950 HOLLYWOOD ROAD SUITE 270
City	SAINT JOSEPH
State	MI
ZIP	49085
Phone	269 982-4310
CertificateType	4
CertificateEffectiveDate	6/1/2022
CertificateExpirationDate	5/31/2024
FacilityType	Waiver

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