42D1081087 CLIA NUMBER - NORTH CENTRAL FAMILY MEDICAL CENTER-CHESTER COMMUNITY MEDICINE FOUNDATION,INC DBA

Laboratory Demographics

CLIA Code: 42D1081087
Facility Name: NORTH CENTRAL FAMILY MEDICAL CENTER-CHESTER COMMUNITY MEDICINE FOUNDATION,INC DBA
Facility Address: 121 SALUDA STREET
CHESTER, SC
ZIP 29706
Facility Phone: 803 325-7744
Facility Type: Federally Qualified Health Center
Facility Type: Microscopy
Lab Director: ROOSEVELT DANIEL
NPI Number: 1992215560
Taxonomy: 261QF0400X - Clinic/Center

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CLIA Record

Field Name	Field Value
CLIA Number	42D1081087
LAB Type	Federally Qualified Health Center
Facility Name	NORTH CENTRAL FAMILY MEDICAL CENTER-CHESTER COMMUNITY MEDICINE FOUNDATION,INC DBA
Street	121 SALUDA STREET
City	CHESTER
State	SC
ZIP	29706
Phone	803 325-7744
Certificate Type	Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description	This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date	12/27/2024
Certificate Expiration Date	12/26/2026
Facility Type	Federally Qualified Health Center
Lab Director	ROOSEVELT DANIEL

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