42D1011689 CLIA NUMBER - MEDICAL UNIVERISTY HOSPITAL AUTHORITY DBA MUSC HEALTH PRIMARY CARE - MERCY ST

Laboratory Demographics

  • CLIA Code: 42D1011689
  • Facility Name: MEDICAL UNIVERISTY HOSPITAL AUTHORITY DBA MUSC HEALTH PRIMARY CARE - MERCY ST
  • Facility Address: 334 MERCY STREET
    LAKE CITY, SC
    ZIP 29560
  • Facility Phone: 843 374-9355
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: DR. TONEY GRAHAM III
  • NPI Number: 1255630174
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 42D1011689
LAB Type Rural Health Clinic
Facility Name MEDICAL UNIVERISTY HOSPITAL AUTHORITY DBA MUSC HEALTH PRIMARY CARE - MERCY ST
Street 334 MERCY STREET
City LAKE CITY
State SC
ZIP 29560
Phone 843 374-9355
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/1/2024
Certificate Expiration Date 9/30/2026
Facility Type Rural Health Clinic
Lab Director DR. TONEY GRAHAM III

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