42D2217107 CLIA NUMBER - MCLEOD PRIMARY CARE NORTH MYRTLE BEACH

Laboratory Demographics

  • CLIA Code: 42D2217107
  • Facility Name: MCLEOD PRIMARY CARE NORTH MYRTLE BEACH
  • Facility Address: 2021 NORTH MYRTLE POINT BLVD, SUITE 101
    NORTH MYRTLE BEACH, SC
    ZIP 29582
  • Facility Phone: (843) 366-2900
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JONESSA A. VILLANUEVA
  • NPI Number: 1609460443
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 42D2217107
LAB Type Physician Office
Facility Name MCLEOD PRIMARY CARE NORTH MYRTLE BEACH
Street 2021 NORTH MYRTLE POINT BLVD, SUITE 101
City NORTH MYRTLE BEACH
State SC
ZIP 29582
Phone 8433662900
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/18/2025
Certificate Expiration Date 3/17/2027
Facility Type Physician Office
Lab Director JONESSA A. VILLANUEVA

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This page was last updated on: 5/18/2026