42D2232975 CLIA NUMBER - PM HEALTH ALLIANCE, LLC

Laboratory Demographics

CLIA Number: 42D2232975

Facility Name: PM HEALTH ALLIANCE, LLC

Facility Address:
588 OLD MOUNT HOLLY RD
GOOSE CREEK, SC
ZIP 29445
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Facility Phone Number: 843 376-5595

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1326590746

Taxonomy: 363LP2300X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	42D2232975
LAB Type	Physician Office
Facility Name	PM HEALTH ALLIANCE, LLC
Street	588 OLD MOUNT HOLLY RD
City	GOOSE CREEK
State	SC
ZIP	29445
Phone	843 376-5595
CertificateType	4
CertificateEffectiveDate	8/19/2023
CertificateExpirationDate	8/18/2025
FacilityType	Waiver

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