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42D2289588 CLIA NUMBER - GREENVILLE FACIAL PLASTIC SURGERY

Laboratory Demographics

CLIA Number: 42D2289588

Facility Name: GREENVILLE FACIAL PLASTIC SURGERY

Facility Address:
914 PENDLETON STREET, SUITE 100
GREENVILLE, SC
ZIP 29601
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Facility Phone Number: 864 990-4240

Facility Type: Other - OFFICE DASED SURGERY

Certificate Type: Waiver
NPI Number: 1073224416

Taxonomy: 261QM2500X - Clinic/Center
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).

CLIA Record

Field Name Field Value
CLIA Number 42D2289588
LAB Type Other - OFFICE DASED SURGERY
Facility Name GREENVILLE FACIAL PLASTIC SURGERY
Street 914 PENDLETON STREET, SUITE 100
City GREENVILLE
State SC
ZIP 29601
Phone 864 990-4240
CertificateType 4
CertificateEffectiveDate 9/13/2023
CertificateExpirationDate 9/12/2025
FacilityType Waiver

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