23D2155083 CLIA NUMBER - UPPER GREAT LAKES FAMILY HEALTH CENTER PEDIATRICS

Laboratory Demographics

CLIA Number: 23D2155083

Facility Name: UPPER GREAT LAKES FAMILY HEALTH CENTER PEDIATRICS

Facility Address:
506 CAMPUS DRIVE SUITE 5
HANCOCK, MI
ZIP 49930
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Facility Phone Number: 906 483-1700

Facility Type: Federally Qualified Health Center

Certificate Type: Waiver

NPI Number: 1205217239

Taxonomy: 1223G0001X - Dentist
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

CLIA Record

Field Name	Field Value
CLIA Number	23D2155083
LAB Type	Federally Qualified Health Center
Facility Name	UPPER GREAT LAKES FAMILY HEALTH CENTER PEDIATRICS
Street	506 CAMPUS DRIVE SUITE 5
City	HANCOCK
State	MI
ZIP	49930
Phone	906 483-1700
CertificateType	4
CertificateEffectiveDate	9/24/2022
CertificateExpirationDate	9/23/2024
FacilityType	Waiver

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