Provider Demographics
NPI:1003446378
Name:C & C MEDICAL LAB, LLC
Entity Type:Organization
Organization Name:C & C MEDICAL LAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:CLYTAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARSON
Authorized Official - Suffix:
Authorized Official - Credentials:RMA
Authorized Official - Phone:864-395-0986
Mailing Address - Street 1:124 EDINBURGH CT STE 109
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-2542
Mailing Address - Country:US
Mailing Address - Phone:864-412-5051
Mailing Address - Fax:
Practice Address - Street 1:124 EDINBURGH CT STE 109
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2542
Practice Address - Country:US
Practice Address - Phone:864-412-5051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-24
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory