23D0708822 CLIA NUMBER - SOUTH SHORE FAMILY PRACTICE P C

Laboratory Demographics

  • CLIA Code: 23D0708822
  • Facility Name: SOUTH SHORE FAMILY PRACTICE P C
  • Facility Address: 107 WEST MAIN STREET
    MARQUETTE, MI
    ZIP 49855
  • Facility Phone: 906 225-3988
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DANIEL D. HARDIE
  • NPI Number: 1720115173
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 23D0708822
LAB Type Physician Office
Facility Name SOUTH SHORE FAMILY PRACTICE P C
Street 107 WEST MAIN STREET
City MARQUETTE
State MI
ZIP 49855
Phone 906 225-3988
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director DANIEL D. HARDIE

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This page was last updated on: 3/20/2025