42D2210767 CLIA NUMBER - EMBER MODERN MEDICINE

Laboratory Demographics

  • CLIA Code: 42D2210767
  • Facility Name: EMBER MODERN MEDICINE
  • Facility Address: 1068 NORTH CHURCH STREET
    GREENVILLE, SC
    ZIP 29601
  • Facility Phone: 864 608-6698
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: BRIAN M. BLANK
  • NPI Number: 1295465763
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 42D2210767
LAB Type Physician Office
Facility Name EMBER MODERN MEDICINE
Street 1068 NORTH CHURCH STREET
City GREENVILLE
State SC
ZIP 29601
Phone 864 608-6698
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 1/22/2025
Certificate Expiration Date 1/21/2027
Facility Type Physician Office
Lab Director BRIAN M. BLANK

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