42D1056705 CLIA NUMBER - DETYENS MEDICAL CENTER

Laboratory Demographics

  • CLIA Code: 42D1056705
  • Facility Name: DETYENS MEDICAL CENTER
  • Facility Address: 1670 DRYDOCK AVE BLDG 10A
    NORTH CHARLESTON, SC
    ZIP 29405
  • Facility Phone: (843) 747-3193
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CHRIS A. RAISPIS
  • NPI Number: 1134720535
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 42D1056705
LAB Type Physician Office
Facility Name DETYENS MEDICAL CENTER
Street 1670 DRYDOCK AVE BLDG 10A
City NORTH CHARLESTON
State SC
ZIP 29405
Phone 8437473193
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/24/2024
Certificate Expiration Date 7/23/2026
Facility Type Physician Office
Lab Director CHRIS A. RAISPIS

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This page was last updated on: 6/29/2026