42D1077100 CLIA NUMBER - SURGERY CENTER AT EDGEWATER,THE CAROLINA SURGERY CENTER LLC DBA

Laboratory Demographics

  • CLIA Code: 42D1077100
  • Facility Name: SURGERY CENTER AT EDGEWATER,THE CAROLINA SURGERY CENTER LLC DBA
  • Facility Address: 2536 LENGERS WAY
    FORT MILL, SC
    ZIP 29708
  • Facility Phone: 803 802-9500
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: BRENDAN TRIBBLE
  • NPI Number: 1467770206
  • Taxonomy: 367500000X - Nurse Anesthetist, Certified Registered

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CLIA Record

Field Name Field Value
CLIA Number 42D1077100
LAB Type Ambulatory Surgery Center
Facility Name SURGERY CENTER AT EDGEWATER,THE CAROLINA SURGERY CENTER LLC DBA
Street 2536 LENGERS WAY
City FORT MILL
State SC
ZIP 29708
Phone 803 802-9500
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/30/2023
Certificate Expiration Date 11/29/2025
Facility Type Ambulatory Surgery Center
Lab Director BRENDAN TRIBBLE

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