23D2112700 CLIA NUMBER - WYOMING DEPT OF PUBLIC SAFETY FIRE SERVICES

Laboratory Demographics

  • CLIA Code: 23D2112700
  • Facility Name: WYOMING DEPT OF PUBLIC SAFETY FIRE SERVICES
  • Facility Address: 1250 36TH STREET SW
    WYOMING, MI
    ZIP 49509
  • Facility Phone: 616 249-3470
  • Facility Type: Mobile Laboratory
  • Facility Type: Waiver
  • Lab Director: BRADLEY S. DORNBOS
  • NPI Number: 1710909767
  • Taxonomy: 122300000X - Dentist

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CLIA Record

Field Name Field Value
CLIA Number 23D2112700
LAB Type Mobile Laboratory
Facility Name WYOMING DEPT OF PUBLIC SAFETY FIRE SERVICES
Street 1250 36TH STREET SW
City WYOMING
State MI
ZIP 49509
Phone 616 249-3470
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/5/2024
Certificate Expiration Date 5/4/2026
Facility Type Mobile Laboratory
Lab Director BRADLEY S. DORNBOS

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