42D2095089 CLIA NUMBER - PROACTIVE MD AT CITY OF SPARTANBURG CITY HALL

Laboratory Demographics

  • CLIA Code: 42D2095089
  • Facility Name: PROACTIVE MD AT CITY OF SPARTANBURG CITY HALL
  • Facility Address: 187 WEST BROAD STREET, 1ST FLOOR
    SPARTANBURG, SC
    ZIP 29303
  • Facility Phone: 864 596-2988
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: LAURA MORRISON
  • NPI Number: 1619535978
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 42D2095089
LAB Type Practitioner Other
Facility Name PROACTIVE MD AT CITY OF SPARTANBURG CITY HALL
Street 187 WEST BROAD STREET, 1ST FLOOR
City SPARTANBURG
State SC
ZIP 29303
Phone 864 596-2988
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/29/2025
Certificate Expiration Date 4/28/2027
Facility Type Practitioner Other
Lab Director LAURA MORRISON

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