34D1005728 CLIA NUMBER - SOUTH PARK SURGICAL CENTER (SPSC)

Laboratory Demographics

  • CLIA Code: 34D1005728
  • Facility Name: SOUTH PARK SURGICAL CENTER (SPSC)
  • Facility Address: 6035 FAIRVIEW ROAD 3RD FLOOR
    CHARLOTTE, NC
    ZIP 28210
  • Facility Phone: 704 295-3004
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: SAJEEV PURI
  • NPI Number: 1225582596
  • Taxonomy: 1223P0300X - Dentist

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 34D1005728
LAB Type Ambulatory Surgery Center
Facility Name SOUTH PARK SURGICAL CENTER (SPSC)
Street 6035 FAIRVIEW ROAD 3RD FLOOR
City CHARLOTTE
State NC
ZIP 28210
Phone 704 295-3004
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/30/2024
Certificate Expiration Date 10/29/2026
Facility Type Ambulatory Surgery Center
Lab Director SAJEEV PURI

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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