42D2043348 CLIA NUMBER - IVY PARK FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 42D2043348
  • Facility Name: IVY PARK FAMILY PRACTICE
  • Facility Address: 111 IVY PARK LANE, SUITE C
    LEXINGTON, SC
    ZIP 29072
  • Facility Phone: 803 785-4555
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: WADE REYNOLDS
  • NPI Number: 1518217389
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 42D2043348
LAB Type Physician Office
Facility Name IVY PARK FAMILY PRACTICE
Street 111 IVY PARK LANE, SUITE C
City LEXINGTON
State SC
ZIP 29072
Phone 803 785-4555
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/2/2024
Certificate Expiration Date 7/1/2026
Facility Type Physician Office
Lab Director WADE REYNOLDS

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