23D2162950 CLIA NUMBER - MUNSON MEDICAL CENTER - DIABETES EDUCATION MUNSON PROFESSIONAL BUILDING

Laboratory Demographics

  • CLIA Code: 23D2162950
  • Facility Name: MUNSON MEDICAL CENTER - DIABETES EDUCATION MUNSON PROFESSIONAL BUILDING
  • Facility Address: 1221 SIXTH STREET SUITE 210
    TRAVERSE CITY, MI
    ZIP 49684
  • Facility Phone: 231 935-8200
  • Facility Type: Other - OUTPATIENT DIABETES ED
  • Facility Type: Waiver
  • Lab Director: VICKIE ALEXANDER
  • NPI Number: 1992478705
  • Taxonomy: 207RH0003X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 23D2162950
LAB Type Other - OUTPATIENT DIABETES ED
Facility Name MUNSON MEDICAL CENTER - DIABETES EDUCATION MUNSON PROFESSIONAL BUILDING
Street 1221 SIXTH STREET SUITE 210
City TRAVERSE CITY
State MI
ZIP 49684
Phone 231 935-8200
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/5/2025
Certificate Expiration Date 3/4/2027
Facility Type Other - OUTPATIENT DIABETES ED
Lab Director VICKIE ALEXANDER

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