42D2291117 CLIA NUMBER - BIG TREE MEDICAL OF NEW ELLENTON

Laboratory Demographics

  • CLIA Code: 42D2291117
  • Facility Name: BIG TREE MEDICAL OF NEW ELLENTON
  • Facility Address: 735 MAIN STREET N
    NEW ELLENTON, SC
    ZIP 29809
  • Facility Phone: 573 814-1170
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CHERYL MARVIN
  • NPI Number: 1740858562
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 42D2291117
LAB Type Physician Office
Facility Name BIG TREE MEDICAL OF NEW ELLENTON
Street 735 MAIN STREET N
City NEW ELLENTON
State SC
ZIP 29809
Phone 573 814-1170
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/5/2023
Certificate Expiration Date 10/4/2025
Facility Type Physician Office
Lab Director CHERYL MARVIN

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