42D2114688 CLIA NUMBER - PS121 MANAGEMENT PA DBA VIDA GYNECOLOGY

Laboratory Demographics

CLIA Number: 42D2114688

Facility Name: PS121 MANAGEMENT PA DBA VIDA GYNECOLOGY

Facility Address:
330C PELHAM ROAD, SUITE A
GREENVILLE, SC
ZIP 29615
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Facility Phone Number: 864 720-1299

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1699252163

Taxonomy: 207V00000X - Obstetrics & Gynecology
An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women.

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
CertificateType	3
CertificateEffectiveDate	6/20/2022
CertificateExpirationDate	6/19/2024
FacilityType	PPMP

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