42D0665587 CLIA NUMBER - POWDERSVILLE FAMILY PRACTICE

Laboratory Demographics

CLIA Number: 42D0665587

Facility Name: POWDERSVILLE FAMILY PRACTICE

Facility Address:
10701 ANDERSON ROAD
EASLEY, SC
ZIP 29642
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Facility Phone Number: 864 295-2500

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1710502455

Taxonomy: 261QH0100X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	42D0665587
LAB Type	Physician Office
Facility Name	POWDERSVILLE FAMILY PRACTICE
Street	10701 ANDERSON ROAD
City	EASLEY
State	SC
ZIP	29642
Phone	864 295-2500
CertificateType	4
CertificateEffectiveDate	9/3/2022
CertificateExpirationDate	9/2/2024
FacilityType	Waiver

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