42D0889221 CLIA NUMBER - PORT ROYAL MEDICAL CENTER

Laboratory Demographics

CLIA Number: 42D0889221

Facility Name: PORT ROYAL MEDICAL CENTER

Facility Address:
1320 S RIBAUT ROAD
PORT ROYAL, SC
ZIP 29935
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Facility Phone Number: 843 986-0900

Facility Type: Community Clinic

Certificate Type: Microscopy

NPI Number: 1942554886

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	42D0889221
LAB Type	Community Clinic
Facility Name	PORT ROYAL MEDICAL CENTER
Street	1320 S RIBAUT ROAD
City	PORT ROYAL
State	SC
ZIP	29935
Phone	843 986-0900
CertificateType	3
CertificateEffectiveDate	7/22/2022
CertificateExpirationDate	7/21/2024
FacilityType	PPMP

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