23D2013566 CLIA NUMBER - COREWELL HEALTH PENNOCK HOSPITAL FAMILY MEDICINE - STATE ST

Laboratory Demographics

  • CLIA Code: 23D2013566
  • Facility Name: COREWELL HEALTH PENNOCK HOSPITAL FAMILY MEDICINE - STATE ST
  • Facility Address: 1108 W STATE STREET SUITE 3
    HASTINGS, MI
    ZIP 49058
  • Facility Phone: 269 945-0922
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: CARL J. BAKER
  • NPI Number: 1396190138
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 23D2013566
LAB Type Rural Health Clinic
Facility Name COREWELL HEALTH PENNOCK HOSPITAL FAMILY MEDICINE - STATE ST
Street 1108 W STATE STREET SUITE 3
City HASTINGS
State MI
ZIP 49058
Phone 269 945-0922
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/19/2024
Certificate Expiration Date 5/18/2026
Facility Type Rural Health Clinic
Lab Director CARL J. BAKER

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