42D1040092 CLIA NUMBER - PALMETTO PEDIATRICS OF CONWAY

Laboratory Demographics

  • CLIA Code: 42D1040092
  • Facility Name: PALMETTO PEDIATRICS OF CONWAY
  • Facility Address: 140 PROFESSIONAL PARK DRIVE
    CONWAY, SC
    ZIP 29526
  • Facility Phone: (843) 234-5678
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: BRIAN M. RABON
  • NPI Number: 1962481531
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 42D1040092
LAB Type Physician Office
Facility Name PALMETTO PEDIATRICS OF CONWAY
Street 140 PROFESSIONAL PARK DRIVE
City CONWAY
State SC
ZIP 29526
Phone 8432345678
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/29/2025
Certificate Expiration Date 4/28/2027
Facility Type Physician Office
Lab Director BRIAN M. RABON

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This page was last updated on: 5/18/2026