42D2022662 CLIA NUMBER - ADVANCED WOUND CLINIC AT SUMMERVILLE MEDICAL CTR

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Laboratory Demographics

CLIA Number: 42D2022662

Facility Name: ADVANCED WOUND CLINIC AT SUMMERVILLE MEDICAL CTR

Facility Address:
105 BURTON AVENUE, SUITE D
SUMMERVILLE, SC
ZIP 29485
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Facility Phone Number: 843 832-5453

Facility Type: Ancillary Testing Site in Health Care Center

Certificate Type: Waiver

NPI Number: 1205921624

Taxonomy: 1223G0001X - Dentist
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

CLIA Record

Field Name	Field Value
CLIA Number	42D2022662
LAB Type	Ancillary Testing Site in Health Care Center
Facility Name	ADVANCED WOUND CLINIC AT SUMMERVILLE MEDICAL CTR
Street	105 BURTON AVENUE, SUITE D
City	SUMMERVILLE
State	SC
ZIP	29485
Phone	843 832-5453
CertificateType	4
CertificateEffectiveDate	4/7/2023
CertificateExpirationDate	4/6/2025
FacilityType	Waiver

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