42D1095674 CLIA NUMBER - NORTH GROVE LAB

Laboratory Demographics

  • CLIA Code: 42D1095674
  • Facility Name: NORTH GROVE LAB
  • Facility Address: 1330 BOILING SPRINGS RD STE 1500
    SPARTANBURG, SC
    ZIP 29303
  • Facility Phone: 864 560-9010
  • Facility Type: Other - OUTPATIENT LAB COLLECTION
  • Facility Type: Waiver
  • Lab Director: DR. MICHAEL P. MIKULASOVICH
  • NPI Number: 1790765980
  • Taxonomy: 261QP0905X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 42D1095674
LAB Type Other - OUTPATIENT LAB COLLECTION
Facility Name NORTH GROVE LAB
Street 1330 BOILING SPRINGS RD STE 1500
City SPARTANBURG
State SC
ZIP 29303
Phone 864 560-9010
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/27/2025
Certificate Expiration Date 7/26/2027
Facility Type Other - OUTPATIENT LAB COLLECTION
Lab Director DR. MICHAEL P. MIKULASOVICH

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