42D0868813 CLIA NUMBER - NORTH CENTRAL FAMILY MEDICAL CENTER DBA COMMUNITY MEDICINE FOUNDATION

Laboratory Demographics

CLIA Code: 42D0868813
Facility Name: NORTH CENTRAL FAMILY MEDICAL CENTER DBA COMMUNITY MEDICINE FOUNDATION
Facility Address: 1131 SALUDA STREET
ROCK HILL, SC
ZIP 29731
Facility Phone: 803 325-7744
Facility Type: Federally Qualified Health Center
Facility Type: Microscopy
Lab Director: DR. ROOSEVELT DANIEL
NPI Number: 1003198136
Taxonomy: 261QC1500X - Clinic/Center

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CLIA Record

Field Name	Field Value
CLIA Number	42D0868813
LAB Type	Federally Qualified Health Center
Facility Name	NORTH CENTRAL FAMILY MEDICAL CENTER DBA COMMUNITY MEDICINE FOUNDATION
Street	1131 SALUDA STREET
City	ROCK HILL
State	SC
ZIP	29731
Phone	803 325-7744
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	12/18/2024
Certificate Expiration Date	12/17/2026
Facility Type	Federally Qualified Health Center
Lab Director	DR. ROOSEVELT DANIEL

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