42D0864419 CLIA NUMBER - BON SECOURS HOLLY TREE FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 42D0864419
  • Facility Name: BON SECOURS HOLLY TREE FAMILY PRACTICE
  • Facility Address: 1338 HIGHWAY 14
    SIMPSONVILLE, SC
    ZIP 29681
  • Facility Phone: 864 297-7091
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. MARK WHITE
  • NPI Number: 1760509814
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 42D0864419
LAB Type Physician Office
Facility Name BON SECOURS HOLLY TREE FAMILY PRACTICE
Street 1338 HIGHWAY 14
City SIMPSONVILLE
State SC
ZIP 29681
Phone 864 297-7091
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/1/2024
Certificate Expiration Date 3/31/2026
Facility Type Physician Office
Lab Director DR. MARK WHITE

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