42D2206049 CLIA NUMBER - PASSPORT HEALTH

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Laboratory Demographics

CLIA Number: 42D2206049

Facility Name: PASSPORT HEALTH

Facility Address:
37 VILLA ROAD #301
GREENVILLE, SC
ZIP 29615
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Facility Phone Number: 480 646-9028

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1619394335

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	42D2206049
LAB Type	Physician Office
Facility Name	PASSPORT HEALTH
Street	37 VILLA ROAD #301
City	GREENVILLE
State	SC
ZIP	29615
Phone	480 646-9028
CertificateType	4
CertificateEffectiveDate	12/17/2022
CertificateExpirationDate	12/16/2024
FacilityType	Waiver

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