42D2013174 CLIA NUMBER - GOOSE CREEK CBOC

Laboratory Demographics

  • CLIA Code: 42D2013174
  • Facility Name: GOOSE CREEK CBOC
  • Facility Address: 2418 NNPTC CIRCLE
    GOOSE CREEK, SC
    ZIP 29445
  • Facility Phone: 843 789-6400
  • Facility Type: Community Clinic
  • Facility Type: Accreditation
  • Lab Director: EDWARD TRACY
  • NPI Number: 1700263886
  • Taxonomy: 1223G0001X - Dentist

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CLIA Record

Field Name Field Value
CLIA Number 42D2013174
LAB Type Community Clinic
Facility Name GOOSE CREEK CBOC
Street 2418 NNPTC CIRCLE
City GOOSE CREEK
State SC
ZIP 29445
Phone 843 789-6400
Certificate Type Certificate of Accreditation
Certificate Type Description This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.
Certificate Effective Date 9/15/2010
Certificate Expiration Date 5/22/2026
Facility Type Community Clinic
Lab Director EDWARD TRACY

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