23D1074718 CLIA NUMBER - COREWELL HEALTH WATERVLIET HOSPITAL PRIMARY CARE

Laboratory Demographics

CLIA Number: 23D1074718

Facility Name: COREWELL HEALTH WATERVLIET HOSPITAL PRIMARY CARE

Facility Address:
400 MEDICAL PARK DRIVE
WATERVLIET, MI
ZIP 49098
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Facility Phone Number: 269 463-3600

Facility Type: Rural Health Clinic

Certificate Type: Waiver

NPI Number: 1023114741

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	23D1074718
LAB Type	Rural Health Clinic
Facility Name	COREWELL HEALTH WATERVLIET HOSPITAL PRIMARY CARE
Street	400 MEDICAL PARK DRIVE
City	WATERVLIET
State	MI
ZIP	49098
Phone	269 463-3600
CertificateType	4
CertificateEffectiveDate	10/4/2023
CertificateExpirationDate	10/3/2025
FacilityType	Waiver

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