42D1103647 CLIA NUMBER - EXPRESS PEDIATRIC CARE, PA

Laboratory Demographics

  • CLIA Code: 42D1103647
  • Facility Name: EXPRESS PEDIATRIC CARE, PA
  • Facility Address: 10 ENTERPRISE BLVD, SUITE 105 EASTSIDE MEDICAL CENTER
    GREENVILLE, SC
    ZIP 29615
  • Facility Phone: 864 551-2422
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. DAWN POLLY
  • NPI Number: 1609259217
  • Taxonomy: 208000000X - Pediatrics

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 42D1103647
LAB Type Physician Office
Facility Name EXPRESS PEDIATRIC CARE, PA
Street 10 ENTERPRISE BLVD, SUITE 105 EASTSIDE MEDICAL CENTER
City GREENVILLE
State SC
ZIP 29615
Phone 864 551-2422
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/14/2025
Certificate Expiration Date 8/13/2027
Facility Type Physician Office
Lab Director DR. DAWN POLLY

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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