23D2089124 CLIA NUMBER - THUNDER BAY COMMUNITY HEALTH SERVICE, INC CHEBOYGAN INTERMEDIATE SCHOOL

Laboratory Demographics

  • CLIA Code: 23D2089124
  • Facility Name: THUNDER BAY COMMUNITY HEALTH SERVICE, INC CHEBOYGAN INTERMEDIATE SCHOOL
  • Facility Address: 905 W LINCOLN AVE
    CHEBOYGAN, MI
    ZIP 49721
  • Facility Phone: 989 742-4583
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Waiver
  • Lab Director: WAYNE MCEWEN
  • NPI Number: 1508270398
  • Taxonomy: 261QF0400X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 23D2089124
LAB Type Federally Qualified Health Center
Facility Name THUNDER BAY COMMUNITY HEALTH SERVICE, INC CHEBOYGAN INTERMEDIATE SCHOOL
Street 905 W LINCOLN AVE
City CHEBOYGAN
State MI
ZIP 49721
Phone 989 742-4583
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/19/2024
Certificate Expiration Date 12/18/2026
Facility Type Federally Qualified Health Center
Lab Director WAYNE MCEWEN

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This page was last updated on: 6/4/2025