39D1017649 CLIA NUMBER - KOLE PLASTIC SURGERY CENTER

Laboratory Demographics

  • CLIA Code: 39D1017649
  • Facility Name: KOLE PLASTIC SURGERY CENTER
  • Facility Address: 1122 STREET RD SUITE 100
    SOUTHAMPTON, PA
    ZIP 18966
  • Facility Phone: 215 354-1010
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: EDWARD S. KOLE DO
  • NPI Number: 1053517169
  • Taxonomy: 208200000X - Plastic Surgery

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CLIA Record

Field Name Field Value
CLIA Number 39D1017649
LAB Type Ambulatory Surgery Center
Facility Name KOLE PLASTIC SURGERY CENTER
Street 1122 STREET RD SUITE 100
City SOUTHAMPTON
State PA
ZIP 18966
Phone 215 354-1010
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/1/2025
Certificate Expiration Date 9/30/2027
Facility Type Ambulatory Surgery Center
Lab Director EDWARD S. KOLE DO

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