42D0916819 CLIA NUMBER - MUSC HEALTH PRIMARY CARE - ST MATTHEWS

Laboratory Demographics

CLIA Number: 42D0916819

Facility Name: MUSC HEALTH PRIMARY CARE - ST MATTHEWS

Facility Address:
651 HARRY C RASOR DRIVE
SAINT MATTHEWS, SC
ZIP 29135
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Facility Phone Number: 803 874-3902

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1396976700

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	42D0916819
LAB Type	Physician Office
Facility Name	MUSC HEALTH PRIMARY CARE - ST MATTHEWS
Street	651 HARRY C RASOR DRIVE
City	SAINT MATTHEWS
State	SC
ZIP	29135
Phone	803 874-3902
CertificateType	3
CertificateEffectiveDate	9/5/2023
CertificateExpirationDate	9/4/2025
FacilityType	PPMP

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