23D2124862 CLIA NUMBER - FAMILY MEDICAL CENTER

Laboratory Demographics

CLIA Number: 23D2124862

Facility Name: FAMILY MEDICAL CENTER

Facility Address:
13101 ALLEN ROAD SUITE 300
SOUTHGATE, MI
ZIP 48195
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Facility Phone Number: 734 850-6902

Facility Type: Federally Qualified Health Center

Certificate Type: Waiver

NPI Number: 1407392970

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	23D2124862
LAB Type	Federally Qualified Health Center
Facility Name	FAMILY MEDICAL CENTER
Street	13101 ALLEN ROAD SUITE 300
City	SOUTHGATE
State	MI
ZIP	48195
Phone	734 850-6902
CertificateType	4
CertificateEffectiveDate	1/26/2023
CertificateExpirationDate	1/25/2025
FacilityType	Waiver

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