42D2179818 CLIA NUMBER - PREMISE HEALTH OF SOUTH CAROLINA MEDICAL, PC

Laboratory Demographics

CLIA Number: 42D2179818

Facility Name: PREMISE HEALTH OF SOUTH CAROLINA MEDICAL, PC

Facility Address:
10 PARKWAY SOUTH
GREENVILLE, SC
ZIP 29615
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Facility Phone Number: 864 458-4420

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1295157139

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	42D2179818
LAB Type	Physician Office
Facility Name	PREMISE HEALTH OF SOUTH CAROLINA MEDICAL, PC
Street	10 PARKWAY SOUTH
City	GREENVILLE
State	SC
ZIP	29615
Phone	864 458-4420
CertificateType	4
CertificateEffectiveDate	3/3/2024
CertificateExpirationDate	3/2/2026
FacilityType	Waiver

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