42D2123449 CLIA NUMBER - LAKESIDE MEDICAL RESPONSE

Laboratory Demographics

CLIA Number: 42D2123449

Facility Name: LAKESIDE MEDICAL RESPONSE

Facility Address:
3658 SOUTH IRBY STREET
FLORENCE, SC
ZIP 29505
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Facility Phone Number: 843 629-7133

Facility Type: Ambulance

Certificate Type: Waiver

NPI Number: 1811085657

Taxonomy: 3416L0300X - Ambulance

CLIA Record

Field Name	Field Value
CLIA Number	42D2123449
LAB Type	Ambulance
Facility Name	LAKESIDE MEDICAL RESPONSE
Street	3658 SOUTH IRBY STREET
City	FLORENCE
State	SC
ZIP	29505
Phone	843 629-7133
CertificateType	4
CertificateEffectiveDate	12/21/2022
CertificateExpirationDate	12/20/2024
FacilityType	Waiver

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