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42D1081929 CLIA NUMBER - PALMETTO PEDIATRIC AND ADOLESCENT CLINIC

Laboratory Demographics

CLIA Number: 42D1081929

Facility Name: PALMETTO PEDIATRIC AND ADOLESCENT CLINIC

Facility Address:
121 BLYTHEWOOD RD
BLYTHEWOOD, SC
ZIP 29016
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Facility Phone Number: 803 788-6360

Facility Type: Physician Office

Certificate Type: Certificate of Compliance
NPI Number: 1063690675

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name Field Value
CLIA Number 42D1081929
LAB Type Physician Office
Facility Name PALMETTO PEDIATRIC AND ADOLESCENT CLINIC
Street 121 BLYTHEWOOD RD
City BLYTHEWOOD
State SC
ZIP 29016
Phone 803 788-6360
CertificateType 2
CertificateEffectiveDate 3/6/2023
CertificateExpirationDate 3/5/2025
FacilityType Compliance

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