42D2158132 CLIA NUMBER - TRIDENT PAIN CENTER

Laboratory Demographics

  • CLIA Code: 42D2158132
  • Facility Name: TRIDENT PAIN CENTER
  • Facility Address: 1930 CHARLIE HALL BOULEVARD
    CHARLESTON, SC
    ZIP 29414
  • Facility Phone: 843 797-3636
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: EDWARD J. NOLAN
  • NPI Number: 1124661194
  • Taxonomy: 207LP2900X - Anesthesiology

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CLIA Record

Field Name Field Value
CLIA Number 42D2158132
LAB Type Physician Office
Facility Name TRIDENT PAIN CENTER
Street 1930 CHARLIE HALL BOULEVARD
City CHARLESTON
State SC
ZIP 29414
Phone 843 797-3636
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/20/2024
Certificate Expiration Date 11/19/2026
Facility Type Physician Office
Lab Director EDWARD J. NOLAN

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