23D2304370 CLIA NUMBER - SURMOUNTING LLC

Laboratory Demographics

  • CLIA Code: 23D2304370
  • Facility Name: SURMOUNTING LLC
  • Facility Address: 12866 FORT STREET
    SOUTHGATE, MI
    ZIP 48195
  • Facility Phone: 313 930-0258
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: INGRID LEWIS
  • NPI Number: 1861249815
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 23D2304370
LAB Type Physician Office
Facility Name SURMOUNTING LLC
Street 12866 FORT STREET
City SOUTHGATE
State MI
ZIP 48195
Phone 313 930-0258
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/13/2024
Certificate Expiration Date 5/12/2026
Facility Type Physician Office
Lab Director INGRID LEWIS

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