23D0869340 CLIA NUMBER - TRINITY HEALTH MEDICAL GROUP, ACADEMIC FAMILY MEDICINE - GRAND RAPIDS CAMPUS

Laboratory Demographics

  • CLIA Code: 23D0869340
  • Facility Name: TRINITY HEALTH MEDICAL GROUP, ACADEMIC FAMILY MEDICINE - GRAND RAPIDS CAMPUS
  • Facility Address: 300 LAFAYETTE AVENUE SE STE 4000
    GRAND RAPIDS, MI
    ZIP 49503
  • Facility Phone: 616 685-6922
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: JEAN B. THOMAS
  • NPI Number: 1700351657
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 23D0869340
LAB Type Physician Office
Facility Name TRINITY HEALTH MEDICAL GROUP, ACADEMIC FAMILY MEDICINE - GRAND RAPIDS CAMPUS
Street 300 LAFAYETTE AVENUE SE STE 4000
City GRAND RAPIDS
State MI
ZIP 49503
Phone 616 685-6922
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 1/25/2025
Certificate Expiration Date 1/24/2027
Facility Type Physician Office
Lab Director JEAN B. THOMAS

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