23D0959302 CLIA NUMBER - PDI GRAND RAPIDS

Laboratory Demographics

CLIA Number: 23D0959302

Facility Name: PDI GRAND RAPIDS

Facility Address:
801 CHERRY STREET, SE
GRAND RAPIDS, MI
ZIP 49506
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Facility Phone Number: 616 458-5100

Facility Type: Other

Certificate Type: Waiver

NPI Number: 1508827023

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	23D0959302
LAB Type	Other
Facility Name	PDI GRAND RAPIDS
Street	801 CHERRY STREET, SE
City	GRAND RAPIDS
State	MI
ZIP	49506
Phone	616 458-5100
CertificateType	4
CertificateEffectiveDate	4/8/2023
CertificateExpirationDate	4/7/2025
FacilityType	Waiver

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