42D1097892 CLIA NUMBER - SWEETGRASS PEDIATRICS

Laboratory Demographics

  • CLIA Code: 42D1097892
  • Facility Name: SWEETGRASS PEDIATRICS
  • Facility Address: 748 OLD ORANGEBURG RD
    SUMMERVILLE, SC
    ZIP 29483
  • Facility Phone: 843 832-8606
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: COLLEEN BOYLSTON, MD
  • NPI Number: 1366001596
  • Taxonomy: 235Z00000X - Speech-Language Pathologist

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CLIA Record

Field Name Field Value
CLIA Number 42D1097892
LAB Type Physician Office
Facility Name SWEETGRASS PEDIATRICS
Street 748 OLD ORANGEBURG RD
City SUMMERVILLE
State SC
ZIP 29483
Phone 843 832-8606
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/7/2025
Certificate Expiration Date 4/6/2027
Facility Type Physician Office
Lab Director COLLEEN BOYLSTON, MD

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