42D1054340 CLIA NUMBER - PALMETTO MEDICAL GROUP, PLLC

Laboratory Demographics

  • CLIA Code: 42D1054340
  • Facility Name: PALMETTO MEDICAL GROUP, PLLC
  • Facility Address: 1040 EDGEWATER CORPORATE PKWY, SUITE 101
    INDIAN LAND, SC
    ZIP 29707
  • Facility Phone: 803 802-4561
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: AMIT G. SHAH
  • NPI Number: 1851916332
  • Taxonomy: 261QD0000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 42D1054340
LAB Type Physician Office
Facility Name PALMETTO MEDICAL GROUP, PLLC
Street 1040 EDGEWATER CORPORATE PKWY, SUITE 101
City INDIAN LAND
State SC
ZIP 29707
Phone 803 802-4561
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/18/2024
Certificate Expiration Date 5/17/2026
Facility Type Physician Office
Lab Director AMIT G. SHAH

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