23D0858110 CLIA NUMBER - CRYSTAL LAKE CLINIC

Laboratory Demographics

  • CLIA Code: 23D0858110
  • Facility Name: CRYSTAL LAKE CLINIC
  • Facility Address: 6227 FRANKFORT HIGHWAY
    BENZONIA, MI
    ZIP 49616
  • Facility Phone: 231 882-9661
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JACOB G. FLYNN
  • NPI Number: 1316177611
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 23D0858110
LAB Type Physician Office
Facility Name CRYSTAL LAKE CLINIC
Street 6227 FRANKFORT HIGHWAY
City BENZONIA
State MI
ZIP 49616
Phone 231 882-9661
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/5/2024
Certificate Expiration Date 11/4/2026
Facility Type Physician Office
Lab Director JACOB G. FLYNN

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