23D0897011 CLIA NUMBER - ASCENSION ST JOSEPH HOSPITAL INTERNAL MEDICINE CLINIC

Laboratory Demographics

CLIA Number: 23D0897011

Facility Name: ASCENSION ST JOSEPH HOSPITAL INTERNAL MEDICINE CLINIC

Facility Address:
295 MAPLE SUITE 202
TAWAS CITY, MI
ZIP 48763
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Facility Phone Number: 989 362-6108

Facility Type: Rural Health Clinic

Certificate Type: Waiver

NPI Number: 1164410841

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	23D0897011
LAB Type	Rural Health Clinic
Facility Name	ASCENSION ST JOSEPH HOSPITAL INTERNAL MEDICINE CLINIC
Street	295 MAPLE SUITE 202
City	TAWAS CITY
State	MI
ZIP	48763
Phone	989 362-6108
CertificateType	4
CertificateEffectiveDate	1/29/2023
CertificateExpirationDate	1/28/2025
FacilityType	Waiver

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