23D2283672 CLIA NUMBER - 12TH STREET INTERNAL MEDICINE AND PEDIATRICS

Laboratory Demographics

  • CLIA Code: 23D2283672
  • Facility Name: 12TH STREET INTERNAL MEDICINE AND PEDIATRICS
  • Facility Address: 3587 12TH STREET
    WAYLAND, MI
    ZIP 49348
  • Facility Phone: 269 792-2263
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JOEL P. VELDHOUSE
  • NPI Number: 1790470409
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 23D2283672
LAB Type Physician Office
Facility Name 12TH STREET INTERNAL MEDICINE AND PEDIATRICS
Street 3587 12TH STREET
City WAYLAND
State MI
ZIP 49348
Phone 269 792-2263
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/12/2025
Certificate Expiration Date 6/11/2027
Facility Type Physician Office
Lab Director JOEL P. VELDHOUSE

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