42D2114461 CLIA NUMBER - PRISMA HEALTH PULMONARY DISEASE

Laboratory Demographics

CLIA Number: 42D2114461

Facility Name: PRISMA HEALTH PULMONARY DISEASE

Facility Address:
890 WEST FARIS ROAD, MMOB, SUITE 580
GREENVILLE, SC
ZIP 29605
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Facility Phone Number: 864 522-1050

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1851000855

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	42D2114461
LAB Type	Physician Office
Facility Name	PRISMA HEALTH PULMONARY DISEASE
Street	890 WEST FARIS ROAD, MMOB, SUITE 580
City	GREENVILLE
State	SC
ZIP	29605
Phone	864 522-1050
CertificateType	4
CertificateEffectiveDate	6/14/2022
CertificateExpirationDate	6/13/2024
FacilityType	Waiver

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