42D2292827 CLIA NUMBER - PROACTIVE MD NORTHEAST COLUMBIA HEALTH CENTER

Laboratory Demographics

  • CLIA Code: 42D2292827
  • Facility Name: PROACTIVE MD NORTHEAST COLUMBIA HEALTH CENTER
  • Facility Address: 131 WILDEWOOD PARK DRIVE
    COLUMBIA, SC
    ZIP 29223
  • Facility Phone: 803 999-4030
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: DR. MICHELLE TRAN
  • NPI Number: 1184498628
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 42D2292827
LAB Type Practitioner Other
Facility Name PROACTIVE MD NORTHEAST COLUMBIA HEALTH CENTER
Street 131 WILDEWOOD PARK DRIVE
City COLUMBIA
State SC
ZIP 29223
Phone 803 999-4030
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/31/2023
Certificate Expiration Date 10/30/2025
Facility Type Practitioner Other
Lab Director DR. MICHELLE TRAN

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