42D1054340 CLIA NUMBER - PALMETTO MEDICAL GROUP, PLLC

Laboratory Demographics

CLIA Number: 42D1054340

Facility Name: PALMETTO MEDICAL GROUP, PLLC

Facility Address:
1040 EDGEWATER CORPORATE PKWY, SUITE 101
INDIAN LAND, SC
ZIP 29707
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Facility Phone Number: 803 802-4561

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1851916332

Taxonomy: 261QD0000X - Clinic/Center

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
CertificateType	4
CertificateEffectiveDate	5/18/2022
CertificateExpirationDate	5/17/2024
FacilityType	Waiver

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