42D1047289 CLIA NUMBER - TRI-COUNTY PEDIATRICS LLC

Laboratory Demographics

CLIA Number: 42D1047289

Facility Name: TRI-COUNTY PEDIATRICS LLC

Facility Address:
815 EAST LIBERTY STREET
YORK, SC
ZIP 29745
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Facility Phone Number: 803 628-2728

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1114066883

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	42D1047289
LAB Type	Physician Office
Facility Name	TRI-COUNTY PEDIATRICS LLC
Street	815 EAST LIBERTY STREET
City	YORK
State	SC
ZIP	29745
Phone	803 628-2728
CertificateType	4
CertificateEffectiveDate	10/31/2023
CertificateExpirationDate	10/30/2025
FacilityType	Waiver

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