23D2019899 CLIA NUMBER - ST JOHNS INTERNAL MEDICINE PC

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Laboratory Demographics

CLIA Number: 23D2019899

Facility Name: ST JOHNS INTERNAL MEDICINE PC

Facility Address:
110 W HIGHAM ST
SAINT JOHNS, MI
ZIP 48879
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Facility Phone Number: 989 224-0646

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1699168708

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	23D2019899
LAB Type	Physician Office
Facility Name	ST JOHNS INTERNAL MEDICINE PC
Street	110 W HIGHAM ST
City	SAINT JOHNS
State	MI
ZIP	48879
Phone	989 224-0646
CertificateType	4
CertificateEffectiveDate	2/9/2023
CertificateExpirationDate	2/8/2025
FacilityType	Waiver

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