42D2138851 CLIA NUMBER - COLONIAL NEUROLOGY & SLEEP LAB

Laboratory Demographics

CLIA Number: 42D2138851

Facility Name: COLONIAL NEUROLOGY & SLEEP LAB

Facility Address:
385 W WESMARK BLVD
SUMTER, SC
ZIP 29150
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Facility Phone Number: 803 619-5718

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1598313827

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	42D2138851
LAB Type	Physician Office
Facility Name	COLONIAL NEUROLOGY & SLEEP LAB
Street	385 W WESMARK BLVD
City	SUMTER
State	SC
ZIP	29150
Phone	803 619-5718
CertificateType	4
CertificateEffectiveDate	10/25/2023
CertificateExpirationDate	10/24/2025
FacilityType	Waiver

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