23D2036900 CLIA NUMBER - SOUTHSIDE HEALTH CENTER

Laboratory Demographics

  • CLIA Code: 23D2036900
  • Facility Name: SOUTHSIDE HEALTH CENTER
  • Facility Address: 2303 KALAMAZOO AVE SE
    GRAND RAPIDS, MI
    ZIP 49507
  • Facility Phone: 616 965-8200
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Waiver
  • Lab Director: JENNY L. BUSH
  • NPI Number: 1386926004
  • Taxonomy: 261QF0400X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 23D2036900
LAB Type Federally Qualified Health Center
Facility Name SOUTHSIDE HEALTH CENTER
Street 2303 KALAMAZOO AVE SE
City GRAND RAPIDS
State MI
ZIP 49507
Phone 616 965-8200
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/9/2025
Certificate Expiration Date 6/8/2027
Facility Type Federally Qualified Health Center
Lab Director JENNY L. BUSH

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