23D1040078 CLIA NUMBER - POTTERVILLE BENTON TWP FIRE & EMS

Laboratory Demographics

  • CLIA Code: 23D1040078
  • Facility Name: POTTERVILLE BENTON TWP FIRE & EMS
  • Facility Address: 4713 HARTEL
    POTTERVILLE, MI
    ZIP 48876
  • Facility Phone: 517 231-3653
  • Facility Type: Ambulance
  • Facility Type: Waiver
  • Lab Director: JACK W. FOX
  • NPI Number: 1508808106
  • Taxonomy: 3416L0300X - Ambulance

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CLIA Record

Field Name Field Value
CLIA Number 23D1040078
LAB Type Ambulance
Facility Name POTTERVILLE BENTON TWP FIRE & EMS
Street 4713 HARTEL
City POTTERVILLE
State MI
ZIP 48876
Phone 517 231-3653
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/29/2025
Certificate Expiration Date 4/28/2027
Facility Type Ambulance
Lab Director JACK W. FOX

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