23D0949535 CLIA NUMBER - PROVIDENCE HOSPITAL EMERGENCY DEPARTMENT ADMINISTRATION FISHER CENTER #112

Laboratory Demographics

  • CLIA Code: 23D0949535
  • Facility Name: PROVIDENCE HOSPITAL EMERGENCY DEPARTMENT ADMINISTRATION FISHER CENTER #112
  • Facility Address: 16001 W NINE MILE ROAD ATTN MAUREEN KELLY-NICHOLS
    SOUTHFIELD, MI
    ZIP 48075
  • Facility Phone: 248 849-3015
  • Facility Type: Other - EMERGENCY DEPT
  • Facility Type: Waiver
  • Lab Director: MARTIN D. HARRIS
  • NPI Number: 1023080694
  • Taxonomy: 207RC0000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 23D0949535
LAB Type Other - EMERGENCY DEPT
Facility Name PROVIDENCE HOSPITAL EMERGENCY DEPARTMENT ADMINISTRATION FISHER CENTER #112
Street 16001 W NINE MILE ROAD ATTN MAUREEN KELLY-NICHOLS
City SOUTHFIELD
State MI
ZIP 48075
Phone 248 849-3015
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/27/2024
Certificate Expiration Date 3/26/2026
Facility Type Other - EMERGENCY DEPT
Lab Director MARTIN D. HARRIS

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