42D2320719 CLIA NUMBER - MIDTOWN PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 42D2320719
  • Facility Name: MIDTOWN PRIMARY CARE
  • Facility Address: 10 ENTERPRISE BLVD SUITE 107
    GREENVILLE, SC
    ZIP 29615
  • Facility Phone: 864 686-6575
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: AYESHA S. NUTT
  • NPI Number: 1023841194
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 42D2320719
LAB Type Physician Office
Facility Name MIDTOWN PRIMARY CARE
Street 10 ENTERPRISE BLVD SUITE 107
City GREENVILLE
State SC
ZIP 29615
Phone 864 686-6575
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/24/2025
Certificate Expiration Date 3/23/2027
Facility Type Physician Office
Lab Director AYESHA S. NUTT

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