42D1051441 CLIA NUMBER - CENTER FOR ORAL & MAXILLOFACIAL SURGERY PA

Laboratory Demographics

  • CLIA Code: 42D1051441
  • Facility Name: CENTER FOR ORAL & MAXILLOFACIAL SURGERY PA
  • Facility Address: 1698 W HWY 160 STE 100
    FORT MILL, SC
    ZIP 29708
  • Facility Phone: 803 802-7700
  • Facility Type: Other
  • Facility Type: Waiver
  • Lab Director: THOMAS H. SIMPSON
  • NPI Number: 1790935336
  • Taxonomy: 104100000X - Social Worker

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CLIA Record

Field Name Field Value
CLIA Number 42D1051441
LAB Type Other
Facility Name CENTER FOR ORAL & MAXILLOFACIAL SURGERY PA
Street 1698 W HWY 160 STE 100
City FORT MILL
State SC
ZIP 29708
Phone 803 802-7700
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/2/2024
Certificate Expiration Date 3/1/2026
Facility Type Other
Lab Director THOMAS H. SIMPSON

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