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42D0251419 CLIA NUMBER - PALMETTO ADULT AND CHILDREN'S UROLOGY

Laboratory Demographics

CLIA Number: 42D0251419

Facility Name: PALMETTO ADULT AND CHILDREN'S UROLOGY

Facility Address:
302 MEDICAL PARK DRIVE SUITE 207
WALTERBORO, SC
ZIP 29488
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Facility Phone Number: 843 797-6600

Facility Type: Physician Office

Certificate Type: Microscopy
NPI Number: 1659351567

Taxonomy: 3416L0300X - Ambulance

CLIA Record

Field Name Field Value
CLIA Number 42D0251419
LAB Type Physician Office
Facility Name PALMETTO ADULT AND CHILDREN'S UROLOGY
Street 302 MEDICAL PARK DRIVE SUITE 207
City WALTERBORO
State SC
ZIP 29488
Phone 843 797-6600
CertificateType 3
CertificateEffectiveDate 9/1/2022
CertificateExpirationDate 8/31/2024
FacilityType PPMP

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This page was last updated on: 4/23/2024