42D1073932 CLIA NUMBER - FOUNTAIN INN DIALYSIS

Laboratory Demographics

  • CLIA Code: 42D1073932
  • Facility Name: FOUNTAIN INN DIALYSIS
  • Facility Address: 298 CHAPMAN RD
    FOUNTAIN INN, SC
    ZIP 29644
  • Facility Phone: 864 862-2273
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: DR. HENRY YU
  • NPI Number: 1770112849
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 42D1073932
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name FOUNTAIN INN DIALYSIS
Street 298 CHAPMAN RD
City FOUNTAIN INN
State SC
ZIP 29644
Phone 864 862-2273
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/19/2023
Certificate Expiration Date 9/18/2025
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director DR. HENRY YU

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This page was last updated on: 6/4/2025