42D2209386 CLIA NUMBER - GRACE INTERNAL MEDICINE WITH MUSC HEALTH

Laboratory Demographics

  • CLIA Code: 42D2209386
  • Facility Name: GRACE INTERNAL MEDICINE WITH MUSC HEALTH
  • Facility Address: 114B HOSPITAL DRIVE
    SIMPSONVILLE, SC
    ZIP 29681
  • Facility Phone: 864 757-5177
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. LEON BUFFALOE
  • NPI Number: 1962120071
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 42D2209386
LAB Type Physician Office
Facility Name GRACE INTERNAL MEDICINE WITH MUSC HEALTH
Street 114B HOSPITAL DRIVE
City SIMPSONVILLE
State SC
ZIP 29681
Phone 864 757-5177
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/13/2025
Certificate Expiration Date 1/12/2027
Facility Type Physician Office
Lab Director DR. LEON BUFFALOE

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This page was last updated on: 9/29/2025