23D2095715 CLIA NUMBER - CHRISTIAN GLOBAL MEDICAL HEALTHCARE INCORPORATED

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Laboratory Demographics

CLIA Number: 23D2095715

Facility Name: CHRISTIAN GLOBAL MEDICAL HEALTHCARE INCORPORATED

Facility Address:
451 W MILHAM AVE
PORTAGE, MI
ZIP 49024
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Facility Phone Number: 269 488-9007

Facility Type: Other - FAMILY PRACTICE URGENT

Certificate Type: Waiver

NPI Number: 1063804995

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	23D2095715
LAB Type	Other - FAMILY PRACTICE URGENT
Facility Name	CHRISTIAN GLOBAL MEDICAL HEALTHCARE INCORPORATED
Street	451 W MILHAM AVE
City	PORTAGE
State	MI
ZIP	49024
Phone	269 488-9007
CertificateType	4
CertificateEffectiveDate	5/11/2023
CertificateExpirationDate	5/10/2025
FacilityType	Waiver

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