23D0899819 CLIA NUMBER - COREWELL HEALTH PENNOCK HOSPITAL FAMILY MEDICINE - GUN LAKE

Laboratory Demographics

CLIA Number: 23D0899819

Facility Name: COREWELL HEALTH PENNOCK HOSPITAL FAMILY MEDICINE - GUN LAKE

Facility Address:
12851 W M-179 HWY
WAYLAND, MI
ZIP 49348
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Facility Phone Number: 877 377-7322

Facility Type: Rural Health Clinic

Certificate Type: Waiver

NPI Number: 1801250907

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	23D0899819
LAB Type	Rural Health Clinic
Facility Name	COREWELL HEALTH PENNOCK HOSPITAL FAMILY MEDICINE - GUN LAKE
Street	12851 W M-179 HWY
City	WAYLAND
State	MI
ZIP	49348
Phone	877 377-7322
CertificateType	4
CertificateEffectiveDate	11/1/2023
CertificateExpirationDate	10/31/2025
FacilityType	Waiver

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