23D2006980 CLIA NUMBER - PROVIDENCE HOSPITAL OF NOVI EMERGENCY ROOM

Laboratory Demographics

  • CLIA Code: 23D2006980
  • Facility Name: PROVIDENCE HOSPITAL OF NOVI EMERGENCY ROOM
  • Facility Address: 47601 GRAND RIVER AVENUE
    NOVI, MI
    ZIP 48374
  • Facility Phone: 248 465-4204
  • Facility Type: Other - EMERGENCY ROOM
  • Facility Type: Waiver
  • Lab Director: GARY W. PILCHAK
  • NPI Number: 1942459672
  • Taxonomy: 207L00000X - Anesthesiology

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CLIA Record

Field Name Field Value
CLIA Number 23D2006980
LAB Type Other - EMERGENCY ROOM
Facility Name PROVIDENCE HOSPITAL OF NOVI EMERGENCY ROOM
Street 47601 GRAND RIVER AVENUE
City NOVI
State MI
ZIP 48374
Phone 248 465-4204
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/26/2024
Certificate Expiration Date 4/25/2026
Facility Type Other - EMERGENCY ROOM
Lab Director GARY W. PILCHAK

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