42D1018654 CLIA NUMBER - GRACE MEDICAL GROUP LLC

Laboratory Demographics

  • CLIA Code: 42D1018654
  • Facility Name: GRACE MEDICAL GROUP LLC
  • Facility Address: 3025 FARROW ROAD
    COLUMBIA, SC
    ZIP 29203
  • Facility Phone: 803 922-0288
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: CYNTHIA L. MATTHEWS-BETTS MD
  • NPI Number: 1346468204
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 42D1018654
LAB Type Physician Office
Facility Name GRACE MEDICAL GROUP LLC
Street 3025 FARROW ROAD
City COLUMBIA
State SC
ZIP 29203
Phone 803 922-0288
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 10/28/2023
Certificate Expiration Date 10/27/2025
Facility Type Physician Office
Lab Director CYNTHIA L. MATTHEWS-BETTS MD

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