23D1087090 CLIA NUMBER - SPRINGPORT MEDICAL CLINIC

Laboratory Demographics

CLIA Number: 23D1087090

Facility Name: SPRINGPORT MEDICAL CLINIC

Facility Address:
400 S MAIN STREET SUITE 200
SPRINGPORT, MI
ZIP 49284
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Facility Phone Number: 517 663-9591

Facility Type: Rural Health Clinic

Certificate Type: Waiver

NPI Number: 1588810709

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	23D1087090
LAB Type	Rural Health Clinic
Facility Name	SPRINGPORT MEDICAL CLINIC
Street	400 S MAIN STREET SUITE 200
City	SPRINGPORT
State	MI
ZIP	49284
Phone	517 663-9591
CertificateType	4
CertificateEffectiveDate	1/2/2024
CertificateExpirationDate	1/1/2026
FacilityType	Waiver

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