42D2194999 CLIA NUMBER - CHARLESTON SOUTHERN UNIVERSITY

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Laboratory Demographics

CLIA Number: 42D2194999

Facility Name: CHARLESTON SOUTHERN UNIVERSITY

Facility Address:
9200 UNIVERSITY BOULEVARD
CHARLESTON, SC
ZIP 29406
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Facility Phone Number: 803 460-3895

Facility Type: Other - SPORT MED TEST PROVIDERS

Certificate Type: Waiver

NPI Number: 1528369667

Taxonomy: 207RH0003X - Internal Medicine
An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered.

CLIA Record

Field Name	Field Value
CLIA Number	42D2194999
LAB Type	Other - SPORT MED TEST PROVIDERS
Facility Name	CHARLESTON SOUTHERN UNIVERSITY
Street	9200 UNIVERSITY BOULEVARD
City	CHARLESTON
State	SC
ZIP	29406
Phone	803 460-3895
CertificateType	4
CertificateEffectiveDate	10/6/2022
CertificateExpirationDate	10/5/2024
FacilityType	Waiver

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