42D0871425 CLIA NUMBER - TIDELANDS HEALTH PEDIATRIC AND ADULT MEDICINE

Laboratory Demographics

  • CLIA Code: 42D0871425
  • Facility Name: TIDELANDS HEALTH PEDIATRIC AND ADULT MEDICINE
  • Facility Address: 64 BUSINESS CENTER DRIVE
    PAWLEYS ISLAND, SC
    ZIP 29585
  • Facility Phone: 843 652-8366
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SCOTT A. NICOL
  • NPI Number: 1275721466
  • Taxonomy: 213E00000X - Podiatrist

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CLIA Record

Field Name Field Value
CLIA Number 42D0871425
LAB Type Physician Office
Facility Name TIDELANDS HEALTH PEDIATRIC AND ADULT MEDICINE
Street 64 BUSINESS CENTER DRIVE
City PAWLEYS ISLAND
State SC
ZIP 29585
Phone 843 652-8366
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/25/2024
Certificate Expiration Date 9/24/2026
Facility Type Physician Office
Lab Director SCOTT A. NICOL

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