42D2055925 CLIA NUMBER - PHYSICIAN'S PAIN AND SPINE CENTER, LLC

Laboratory Demographics

  • CLIA Code: 42D2055925
  • Facility Name: PHYSICIAN'S PAIN AND SPINE CENTER, LLC
  • Facility Address: 3227-F SUNSET BLVD, BLDG F, STE 102
    WEST COLUMBIA, SC
    ZIP 29169
  • Facility Phone: 803 724-2336
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KENNETH R. GROSSLIGHT
  • NPI Number: 1033170550
  • Taxonomy: 225100000X - Physical Therapist

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CLIA Record

Field Name Field Value
CLIA Number 42D2055925
LAB Type Physician Office
Facility Name PHYSICIAN'S PAIN AND SPINE CENTER, LLC
Street 3227-F SUNSET BLVD, BLDG F, STE 102
City WEST COLUMBIA
State SC
ZIP 29169
Phone 803 724-2336
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/19/2025
Certificate Expiration Date 3/18/2027
Facility Type Physician Office
Lab Director KENNETH R. GROSSLIGHT

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