23D1033113 CLIA NUMBER - COREWELL HEALTH GRH SURGERY - 4069 LAKE DR

Laboratory Demographics

  • CLIA Code: 23D1033113
  • Facility Name: COREWELL HEALTH GRH SURGERY - 4069 LAKE DR
  • Facility Address: 4069 LAKE DRIVE SE SUITE 312
    GRAND RAPIDS, MI
    ZIP 49546
  • Facility Phone: 616 285-1120
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: KENNETH D. MINKS
  • NPI Number: 1811983000
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 23D1033113
LAB Type Ambulatory Surgery Center
Facility Name COREWELL HEALTH GRH SURGERY - 4069 LAKE DR
Street 4069 LAKE DRIVE SE SUITE 312
City GRAND RAPIDS
State MI
ZIP 49546
Phone 616 285-1120
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/16/2025
Certificate Expiration Date 2/15/2027
Facility Type Ambulatory Surgery Center
Lab Director KENNETH D. MINKS

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