CLIA lab
CLIA 23D1085454: Pine Tree Medical Center
Waterford, MI. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 23D1085454 belongs to Pine Tree Medical Center in Waterford, MI.
Certificate of Waiver, effective June 18, 2026, expires June 17, 2028.
Active in the CMS Provider of Services file posted October 16, 2026.
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
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Certificate
- Certificate type
- Certificate of Waiver
- Certificate effective
- June 18, 2026
- Certificate expiration
- June 17, 2028
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- June 18, 2008
- Facility type
- Physician office
- Ownership (control type)
- Proprietary
- Lab classification
- CLIA laboratory
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
Lab and contact
- CLIA number
- 23D1085454
- Lab name
- Pine Tree Medical Center
- Address
- 4186 Pontiac Lake Road, Waterford, MI 48328
- Phone
- (248) 674-7337
- Fax
- (248) 674-7335
Annual test volume the lab reported
- Waived tests
- 3,000
Volumes are what the lab reported to CMS on its CMS-116 application, as carried in the file.
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- Cory J Rubin MD PCCertificate of Waiver, Physician office23D2171170
- Devyani Khambete MD PCCertificate of Waiver, Physician office23D1049625
- First Choice Urgent Care - WaterfordCertificate of Waiver, Ancillary test site23D2079803
- First Choice Urgent Care - Waterford - HighlandCertificate of Waiver, Ancillary test site23D2349843
- Glenn Bauer MDCertificate of Waiver, Physician office23D0712430
Related
Questions
What is the CLIA number for Pine Tree Medical Center in Waterford?
23D1085454, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does Pine Tree Medical Center hold?
A Certificate of Waiver, according to the CMS file.
When does CLIA 23D1085454 expire?
The CMS file lists June 17, 2028 as the certificate expiration date; the certificate took effect June 18, 2026.