23D2047589 CLIA NUMBER - SOUTHSIDE PEDIATRICS

Laboratory Demographics

  • CLIA Code: 23D2047589
  • Facility Name: SOUTHSIDE PEDIATRICS
  • Facility Address: 300 MEADOW RUN DRIVE
    HASTINGS, MI
    ZIP 49058
  • Facility Phone: 269 818-1020
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CARRIE L. WILGUS
  • NPI Number: 1912252909
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 23D2047589
LAB Type Physician Office
Facility Name SOUTHSIDE PEDIATRICS
Street 300 MEADOW RUN DRIVE
City HASTINGS
State MI
ZIP 49058
Phone 269 818-1020
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/26/2024
Certificate Expiration Date 9/25/2026
Facility Type Physician Office
Lab Director CARRIE L. WILGUS

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