42D2024647 CLIA NUMBER - PALMETTO ENDOSCOPY SUITE, LLC

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Laboratory Demographics

CLIA Number: 42D2024647

Facility Name: PALMETTO ENDOSCOPY SUITE, LLC

Facility Address:
1520 TAYLOR STREET, SUITE 250
COLUMBIA, SC
ZIP 29201
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Facility Phone Number: 803 799-8098

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1932464476

Taxonomy: 101YP2500X - Counselor

CLIA Record

Field Name	Field Value
CLIA Number	42D2024647
LAB Type	Ambulatory Surgery Center
Facility Name	PALMETTO ENDOSCOPY SUITE, LLC
Street	1520 TAYLOR STREET, SUITE 250
City	COLUMBIA
State	SC
ZIP	29201
Phone	803 799-8098
CertificateType	4
CertificateEffectiveDate	5/20/2023
CertificateExpirationDate	5/19/2025
FacilityType	Waiver

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