23D2119847 CLIA NUMBER - MUNSON HEALTHCARE CHARLEVOIX PEDIATRICS

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Laboratory Demographics

CLIA Number: 23D2119847

Facility Name: MUNSON HEALTHCARE CHARLEVOIX PEDIATRICS

Facility Address:
14719 W UPRIGHT
CHARLEVOIX, MI
ZIP 49720
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Facility Phone Number: 231 547-3840

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1326681461

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	23D2119847
LAB Type	Physician Office
Facility Name	MUNSON HEALTHCARE CHARLEVOIX PEDIATRICS
Street	14719 W UPRIGHT
City	CHARLEVOIX
State	MI
ZIP	49720
Phone	231 547-3840
CertificateType	4
CertificateEffectiveDate	10/5/2022
CertificateExpirationDate	10/4/2024
FacilityType	Waiver

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