42D2277320 CLIA NUMBER - KID CARE PEDIATRIC URGENT CARE, LLC

Laboratory Demographics

CLIA Number: 42D2277320

Facility Name: KID CARE PEDIATRIC URGENT CARE, LLC

Facility Address:
212 MAIN STREET, SUITE A
CONWAY, SC
ZIP 29526
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Facility Phone Number: 843 340-2672

Facility Type: Other - LOCATION PEDIATRIC URGENT

Certificate Type: Waiver

NPI Number: 1255039707

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	42D2277320
LAB Type	Other - LOCATION PEDIATRIC URGENT
Facility Name	KID CARE PEDIATRIC URGENT CARE, LLC
Street	212 MAIN STREET, SUITE A
City	CONWAY
State	SC
ZIP	29526
Phone	843 340-2672
CertificateType	4
CertificateEffectiveDate	2/24/2023
CertificateExpirationDate	2/23/2025
FacilityType	Waiver

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