42D2192411 CLIA NUMBER - TRIDENT PAIN CENTER, LLC

Laboratory Demographics

  • CLIA Code: 42D2192411
  • Facility Name: TRIDENT PAIN CENTER, LLC
  • Facility Address: 9267-G MEDICAL PLAZA DRIVE
    NORTH CHARLESTON, SC
    ZIP 29406
  • Facility Phone: 843 266-6085
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: EDWARD J. NOLAN
  • NPI Number: 1437793353
  • Taxonomy: 208VP0000X - Pain Medicine

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CLIA Record

Field Name Field Value
CLIA Number 42D2192411
LAB Type Physician Office
Facility Name TRIDENT PAIN CENTER, LLC
Street 9267-G MEDICAL PLAZA DRIVE
City NORTH CHARLESTON
State SC
ZIP 29406
Phone 843 266-6085
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/10/2024
Certificate Expiration Date 9/9/2026
Facility Type Physician Office
Lab Director EDWARD J. NOLAN

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