42D2273156 CLIA NUMBER - LEADS WAY MEDICAL CENTER

Laboratory Demographics

CLIA Number: 42D2273156

Facility Name: LEADS WAY MEDICAL CENTER

Facility Address:
11382 N JACOB SMART BLVD, SUITE D
RIDGELAND, SC
ZIP 29936
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Facility Phone Number: 843 441-9415

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1962119487

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	42D2273156
LAB Type	Physician Office
Facility Name	LEADS WAY MEDICAL CENTER
Street	11382 N JACOB SMART BLVD, SUITE D
City	RIDGELAND
State	SC
ZIP	29936
Phone	843 441-9415
CertificateType	4
CertificateEffectiveDate	12/7/2022
CertificateExpirationDate	12/6/2024
FacilityType	Waiver

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