42D2114688 CLIA NUMBER - PS121 MANAGEMENT PA DBA VIDA GYNECOLOGY

Laboratory Demographics

  • CLIA Code: 42D2114688
  • Facility Name: PS121 MANAGEMENT PA DBA VIDA GYNECOLOGY
  • Facility Address: 330C PELHAM ROAD, SUITE A
    GREENVILLE, SC
    ZIP 29615
  • Facility Phone: 864 720-1299
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: KIMBERLY S. HOLLOWAY
  • NPI Number: 1699252163
  • Taxonomy: 207V00000X - Obstetrics & Gynecology

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CLIA Record

Field Name Field Value
CLIA Number 42D2114688
LAB Type Physician Office
Facility Name PS121 MANAGEMENT PA DBA VIDA GYNECOLOGY
Street 330C PELHAM ROAD, SUITE A
City GREENVILLE
State SC
ZIP 29615
Phone 864 720-1299
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 6/20/2024
Certificate Expiration Date 6/19/2026
Facility Type Physician Office
Lab Director KIMBERLY S. HOLLOWAY

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