23D2168433 CLIA NUMBER - SPECTRUM HEALTH MEDICAL GROUP

Laboratory Demographics

CLIA Number: 23D2168433

Facility Name: SPECTRUM HEALTH MEDICAL GROUP

Facility Address:
1725 PORT SHELDON ST
JENISON, MI
ZIP 49428
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Facility Phone Number: 616 667-1725

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1700441904

Taxonomy: 310400000X - Assisted Living Facility
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

CLIA Record

Field Name	Field Value
CLIA Number	23D2168433
LAB Type	Physician Office
Facility Name	SPECTRUM HEALTH MEDICAL GROUP
Street	1725 PORT SHELDON ST
City	JENISON
State	MI
ZIP	49428
Phone	616 667-1725
CertificateType	4
CertificateEffectiveDate	6/28/2023
CertificateExpirationDate	6/27/2025
FacilityType	Waiver

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