23D2170773 CLIA NUMBER - PENTWATER FIRE/RESCUE

Laboratory Demographics

  • CLIA Code: 23D2170773
  • Facility Name: PENTWATER FIRE/RESCUE
  • Facility Address: 486 E PARK ST
    PENTWATER, MI
    ZIP 49449
  • Facility Phone: 231 742-2058
  • Facility Type: Ambulance
  • Facility Type: Waiver
  • Lab Director: JONATHAN D. HUGHART
  • NPI Number: 1932317450
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 23D2170773
LAB Type Ambulance
Facility Name PENTWATER FIRE/RESCUE
Street 486 E PARK ST
City PENTWATER
State MI
ZIP 49449
Phone 231 742-2058
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/20/2025
Certificate Expiration Date 8/19/2027
Facility Type Ambulance
Lab Director JONATHAN D. HUGHART

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