23D0874583 CLIA NUMBER - COREWELL HEALTH SOUTHWESTERN MEDICAL PRIMARY CARE, ST JOSEPH

Laboratory Demographics

  • CLIA Code: 23D0874583
  • Facility Name: COREWELL HEALTH SOUTHWESTERN MEDICAL PRIMARY CARE, ST JOSEPH
  • Facility Address: 4077 S CLEVELAND AVENUE
    ST JOSEPH, MI
    ZIP 49085
  • Facility Phone: 269 429-2992
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DOUGLAS TACKET
  • NPI Number: 1710483110
  • Taxonomy: 261Q00000X - Clinic/Center

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 23D0874583
LAB Type Physician Office
Facility Name COREWELL HEALTH SOUTHWESTERN MEDICAL PRIMARY CARE, ST JOSEPH
Street 4077 S CLEVELAND AVENUE
City ST JOSEPH
State MI
ZIP 49085
Phone 269 429-2992
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/23/2024
Certificate Expiration Date 4/22/2026
Facility Type Physician Office
Lab Director DOUGLAS TACKET

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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