23D1068765 CLIA NUMBER - PORTAGE TOWNSHIP AMBULANCE

Laboratory Demographics

CLIA Number: 23D1068765

Facility Name: PORTAGE TOWNSHIP AMBULANCE

Facility Address:
W17361 DAVIS STREET
CURTIS, MI
ZIP 49820
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Facility Phone Number: 906 586-3574

Facility Type: Ambulance

Certificate Type: Waiver

NPI Number: 1619029980

Taxonomy: 3416L0300X - Ambulance

CLIA Record

Field Name	Field Value
CLIA Number	23D1068765
LAB Type	Ambulance
Facility Name	PORTAGE TOWNSHIP AMBULANCE
Street	W17361 DAVIS STREET
City	CURTIS
State	MI
ZIP	49820
Phone	906 586-3574
CertificateType	4
CertificateEffectiveDate	5/21/2023
CertificateExpirationDate	5/20/2025
FacilityType	Waiver

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