42D1044508 CLIA NUMBER - AID UPSTATE

Laboratory Demographics

CLIA Number: 42D1044508

Facility Name: AID UPSTATE

Facility Address:
811 PENDLETON ST BLDG #10
GREENVILLE, SC
ZIP 29601
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Facility Phone Number: 864 250-0607

Facility Type: Other

Certificate Type: Waiver

NPI Number: 1023563459

Taxonomy: 261QM2500X - Clinic/Center
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).

CLIA Record

Field Name	Field Value
CLIA Number	42D1044508
LAB Type	Other
Facility Name	AID UPSTATE
Street	811 PENDLETON ST BLDG #10
City	GREENVILLE
State	SC
ZIP	29601
Phone	864 250-0607
CertificateType	4
CertificateEffectiveDate	8/22/2023
CertificateExpirationDate	8/21/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024