42D2257229 CLIA NUMBER - ANGELIC PALLIATIVE CARE OF SC, LLC

Laboratory Demographics

  • CLIA Code: 42D2257229
  • Facility Name: ANGELIC PALLIATIVE CARE OF SC, LLC
  • Facility Address: 923 MEDICAL CENTER CIRCLE
    MYRTLE BEACH, SC
    ZIP 29572
  • Facility Phone: 843 356-9078
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: MS. SHANNON JACOBSON
  • NPI Number: 1891448064
  • Taxonomy: 363LC1500X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 42D2257229
LAB Type Practitioner Other
Facility Name ANGELIC PALLIATIVE CARE OF SC, LLC
Street 923 MEDICAL CENTER CIRCLE
City MYRTLE BEACH
State SC
ZIP 29572
Phone 843 356-9078
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/1/2024
Certificate Expiration Date 3/31/2026
Facility Type Practitioner Other
Lab Director MS. SHANNON JACOBSON

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