42D2237543 CLIA NUMBER - PRISMA HEALTH PRIMARY CARE FOUNTAIN INN

Laboratory Demographics

  • CLIA Code: 42D2237543
  • Facility Name: PRISMA HEALTH PRIMARY CARE FOUNTAIN INN
  • Facility Address: 200 N NELSON DRIVE
    FOUNTAIN INN, SC
    ZIP 29644
  • Facility Phone: 864 522-6270
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: JEREMY M. BYRD
  • NPI Number: 1205414828
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 42D2237543
LAB Type Rural Health Clinic
Facility Name PRISMA HEALTH PRIMARY CARE FOUNTAIN INN
Street 200 N NELSON DRIVE
City FOUNTAIN INN
State SC
ZIP 29644
Phone 864 522-6270
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/27/2025
Certificate Expiration Date 9/26/2027
Facility Type Rural Health Clinic
Lab Director JEREMY M. BYRD

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