23D2103176 CLIA NUMBER - CRYSTAL LAKE CLINIC, PC

Laboratory Demographics

  • CLIA Code: 23D2103176
  • Facility Name: CRYSTAL LAKE CLINIC, PC
  • Facility Address: 124 AMES STREET
    ELK RAPIDS, MI
    ZIP 49629
  • Facility Phone: 231 882-9661
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JACOB G. FLYNN
  • NPI Number: 1164945978
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 23D2103176
LAB Type Physician Office
Facility Name CRYSTAL LAKE CLINIC, PC
Street 124 AMES STREET
City ELK RAPIDS
State MI
ZIP 49629
Phone 231 882-9661
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/7/2025
Certificate Expiration Date 10/6/2027
Facility Type Physician Office
Lab Director JACOB G. FLYNN

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