42D2315476 CLIA NUMBER - PREMIER SURGERY CENTER OF THE CAROLINAS LLC

Laboratory Demographics

  • CLIA Code: 42D2315476
  • Facility Name: PREMIER SURGERY CENTER OF THE CAROLINAS LLC
  • Facility Address: 1170 EDGEWATER CORPORATE PARKWAY
    FORT MILL, SC
    ZIP 29707
  • Facility Phone: 914 980-0738
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: MAC IVAN
  • NPI Number: 1023839438
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 42D2315476
LAB Type Ambulatory Surgery Center
Facility Name PREMIER SURGERY CENTER OF THE CAROLINAS LLC
Street 1170 EDGEWATER CORPORATE PARKWAY
City FORT MILL
State SC
ZIP 29707
Phone 914 980-0738
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/13/2024
Certificate Expiration Date 12/12/2026
Facility Type Ambulatory Surgery Center
Lab Director MAC IVAN

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This page was last updated on: 6/4/2025