23D0892491 CLIA NUMBER - CRYSTAL LAKE CLINIC P C - BEAR LAKE

Laboratory Demographics

  • CLIA Code: 23D0892491
  • Facility Name: CRYSTAL LAKE CLINIC P C - BEAR LAKE
  • Facility Address: 8225 LAKE STREET
    BEAR LAKE, MI
    ZIP 49614
  • Facility Phone: 616 864-3314
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JACOB G. FLYNN
  • NPI Number: 1902851777
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 23D0892491
LAB Type Physician Office
Facility Name CRYSTAL LAKE CLINIC P C - BEAR LAKE
Street 8225 LAKE STREET
City BEAR LAKE
State MI
ZIP 49614
Phone 616 864-3314
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/30/2024
Certificate Expiration Date 9/29/2026
Facility Type Physician Office
Lab Director JACOB G. FLYNN

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