42D0965964 CLIA NUMBER - CHARLESTON ENT ASSOCIATES LLC SURGERY CENTER OF CHARLESTON

Laboratory Demographics

CLIA Number: 42D0965964

Facility Name: CHARLESTON ENT ASSOCIATES LLC SURGERY CENTER OF CHARLESTON

Facility Address:
1849 SAVAGE ROAD
CHARLESTON, SC
ZIP 29407
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Facility Phone Number: 843 766-7103

Facility Type: Other

Certificate Type: Waiver

NPI Number: 1053453803

Taxonomy: 207V00000X - Obstetrics & Gynecology
An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women.

CLIA Record

Field Name	Field Value
CLIA Number	42D0965964
LAB Type	Other
Facility Name	CHARLESTON ENT ASSOCIATES LLC SURGERY CENTER OF CHARLESTON
Street	1849 SAVAGE ROAD
City	CHARLESTON
State	SC
ZIP	29407
Phone	843 766-7103
CertificateType	4
CertificateEffectiveDate	10/5/2023
CertificateExpirationDate	10/4/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024