42D1057508 CLIA NUMBER - BLYTHEWOOD MEDICAL ASSOCIATES

Laboratory Demographics

  • CLIA Code: 42D1057508
  • Facility Name: BLYTHEWOOD MEDICAL ASSOCIATES
  • Facility Address: 428 2 MCNULTY PLAZA
    BLYTHEWOOD, SC
    ZIP 29016
  • Facility Phone: 803 754-8941
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ROGER A. GADDY
  • NPI Number: 1689291783
  • Taxonomy: 235Z00000X - Speech-Language Pathologist

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CLIA Record

Field Name Field Value
CLIA Number 42D1057508
LAB Type Physician Office
Facility Name BLYTHEWOOD MEDICAL ASSOCIATES
Street 428 2 MCNULTY PLAZA
City BLYTHEWOOD
State SC
ZIP 29016
Phone 803 754-8941
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/2/2023
Certificate Expiration Date 10/1/2025
Facility Type Physician Office
Lab Director ROGER A. GADDY

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