42D0253234 CLIA NUMBER - BON SECOURS PRIMARY CARE FOUNTAIN INN

Laboratory Demographics

  • CLIA Code: 42D0253234
  • Facility Name: BON SECOURS PRIMARY CARE FOUNTAIN INN
  • Facility Address: 910 NORTH MAIN STREET
    FOUNTAIN INN, SC
    ZIP 29644
  • Facility Phone: 864 967-4982
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DIVYA KULKARNI
  • NPI Number: 1083645584
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 42D0253234
LAB Type Physician Office
Facility Name BON SECOURS PRIMARY CARE FOUNTAIN INN
Street 910 NORTH MAIN STREET
City FOUNTAIN INN
State SC
ZIP 29644
Phone 864 967-4982
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 12/1/2024
Certificate Expiration Date 11/30/2026
Facility Type Physician Office
Lab Director DIVYA KULKARNI

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