42D1014500 CLIA NUMBER - LONG BAY DIAGNOSTIC IMAGING

Laboratory Demographics

  • CLIA Code: 42D1014500
  • Facility Name: LONG BAY DIAGNOSTIC IMAGING
  • Facility Address: 900 21ST AVE NORTH
    MYRTLE BEACH, SC
    ZIP 29577
  • Facility Phone: 843 916-1700
  • Facility Type: Other
  • Facility Type: Waiver
  • Lab Director: GERALD CONGDON MD
  • NPI Number: 1114985397
  • Taxonomy: 2085R0202X - Radiology

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CLIA Record

Field Name Field Value
CLIA Number 42D1014500
LAB Type Other
Facility Name LONG BAY DIAGNOSTIC IMAGING
Street 900 21ST AVE NORTH
City MYRTLE BEACH
State SC
ZIP 29577
Phone 843 916-1700
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/24/2024
Certificate Expiration Date 3/23/2026
Facility Type Other
Lab Director GERALD CONGDON MD

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