23D0704669 CLIA NUMBER - RAVENNA FAMILY PRACTICE PC

Laboratory Demographics

  • CLIA Code: 23D0704669
  • Facility Name: RAVENNA FAMILY PRACTICE PC
  • Facility Address: 12520 CROCKERY CREEK DR PO BOX 179
    RAVENNA, MI
    ZIP 49451
  • Facility Phone: 616 853-6089
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: TIMOTHY L. BEECHNAU
  • NPI Number: 1497928469
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 23D0704669
LAB Type Physician Office
Facility Name RAVENNA FAMILY PRACTICE PC
Street 12520 CROCKERY CREEK DR PO BOX 179
City RAVENNA
State MI
ZIP 49451
Phone 616 853-6089
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director TIMOTHY L. BEECHNAU

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