42D2254141 CLIA NUMBER - HALO PRIMARY CARE, LLC

Laboratory Demographics

  • CLIA Code: 42D2254141
  • Facility Name: HALO PRIMARY CARE, LLC
  • Facility Address: 40 OKATIE CENTER BLVD S, SUITE 215
    OKATIE, SC
    ZIP 29909
  • Facility Phone: 843 603-4800
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: BETHANY GAULTNEY
  • NPI Number: 1639844509
  • Taxonomy: 363LP2300X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 42D2254141
LAB Type Physician Office
Facility Name HALO PRIMARY CARE, LLC
Street 40 OKATIE CENTER BLVD S, SUITE 215
City OKATIE
State SC
ZIP 29909
Phone 843 603-4800
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/1/2024
Certificate Expiration Date 2/28/2026
Facility Type Physician Office
Lab Director BETHANY GAULTNEY

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