42D0251269 CLIA NUMBER - PALMETTO PRIMARY CARE-ST STEPHENS

Laboratory Demographics

  • CLIA Code: 42D0251269
  • Facility Name: PALMETTO PRIMARY CARE-ST STEPHENS
  • Facility Address: 104 FUNK AVENUE
    SAINT STEPHEN, SC
    ZIP 29479
  • Facility Phone: 843 820-3390
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: CLAY ANDERSON
  • NPI Number: 1508830217
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 42D0251269
LAB Type Physician Office
Facility Name PALMETTO PRIMARY CARE-ST STEPHENS
Street 104 FUNK AVENUE
City SAINT STEPHEN
State SC
ZIP 29479
Phone 843 820-3390
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 8/27/2025
Certificate Expiration Date 8/26/2027
Facility Type Physician Office
Lab Director CLAY ANDERSON

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