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23D0864839 CLIA NUMBER - BRONSON SOUTH HAVEN INTERNAL MEDICINE

Laboratory Demographics

CLIA Number: 23D0864839

Facility Name: BRONSON SOUTH HAVEN INTERNAL MEDICINE

Facility Address:
955 S BAILEY
SOUTH HAVEN, MI
ZIP 49090
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Facility Phone Number: 269 639-2777

Facility Type: Physician Office

Certificate Type: Microscopy
NPI Number: 1467539502

Taxonomy: 251E00000X - Home Health
A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety.

CLIA Record

Field Name Field Value
CLIA Number 23D0864839
LAB Type Physician Office
Facility Name BRONSON SOUTH HAVEN INTERNAL MEDICINE
Street 955 S BAILEY
City SOUTH HAVEN
State MI
ZIP 49090
Phone 269 639-2777
CertificateType 3
CertificateEffectiveDate 6/30/2022
CertificateExpirationDate 6/29/2024
FacilityType PPMP

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