23D1047028 CLIA NUMBER - GRAND RIVER ENDOSCOPY CENTER LLC

Laboratory Demographics

  • CLIA Code: 23D1047028
  • Facility Name: GRAND RIVER ENDOSCOPY CENTER LLC
  • Facility Address: 310 LAFAYETTE AVENUE SE SUITE 200
    GRAND RAPIDS, MI
    ZIP 49503
  • Facility Phone: 616 752-5890
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: KENNETH LOWN
  • NPI Number: 1043288467
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 23D1047028
LAB Type Ambulatory Surgery Center
Facility Name GRAND RIVER ENDOSCOPY CENTER LLC
Street 310 LAFAYETTE AVENUE SE SUITE 200
City GRAND RAPIDS
State MI
ZIP 49503
Phone 616 752-5890
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/25/2023
Certificate Expiration Date 10/24/2025
Facility Type Ambulatory Surgery Center
Lab Director KENNETH LOWN

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