23D1058632 CLIA NUMBER - SIXTY FOURTH STREET LLC

Laboratory Demographics

  • CLIA Code: 23D1058632
  • Facility Name: SIXTY FOURTH STREET LLC
  • Facility Address: 2373 64TH STREET SUITE 2200
    BYRON CENTER, MI
    ZIP 49315
  • Facility Phone: 616 685-3975
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: TIMOTHY HENNE
  • NPI Number: 1164538286
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 23D1058632
LAB Type Ambulatory Surgery Center
Facility Name SIXTY FOURTH STREET LLC
Street 2373 64TH STREET SUITE 2200
City BYRON CENTER
State MI
ZIP 49315
Phone 616 685-3975
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/11/2024
Certificate Expiration Date 9/10/2026
Facility Type Ambulatory Surgery Center
Lab Director TIMOTHY HENNE

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