42D0957415 CLIA NUMBER - SANDHILLS PEDIATRICS AT DUTCH FORK

Laboratory Demographics

  • CLIA Code: 42D0957415
  • Facility Name: SANDHILLS PEDIATRICS AT DUTCH FORK
  • Facility Address: 7941 BROAD RIVER ROAD
    IRMO, SC
    ZIP 29063
  • Facility Phone: 803 407-0704
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: JONATHAN BROCK
  • NPI Number: 1891774287
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 42D0957415
LAB Type Physician Office
Facility Name SANDHILLS PEDIATRICS AT DUTCH FORK
Street 7941 BROAD RIVER ROAD
City IRMO
State SC
ZIP 29063
Phone 803 407-0704
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 1/11/2024
Certificate Expiration Date 1/10/2026
Facility Type Physician Office
Lab Director JONATHAN BROCK

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