42D2321902 CLIA NUMBER - PORT CITY PLASTIC SURGERY

Laboratory Demographics

  • CLIA Code: 42D2321902
  • Facility Name: PORT CITY PLASTIC SURGERY
  • Facility Address: 2683 LAKE PARK DR
    NORTH CHARLESTON, SC
    ZIP 29406
  • Facility Phone: 843 518-5000
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: BRIAN G. WIDENHOUSE
  • NPI Number: 1437385788
  • Taxonomy: 2086S0122X - Surgery

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CLIA Record

Field Name Field Value
CLIA Number 42D2321902
LAB Type Physician Office
Facility Name PORT CITY PLASTIC SURGERY
Street 2683 LAKE PARK DR
City NORTH CHARLESTON
State SC
ZIP 29406
Phone 843 518-5000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/11/2025
Certificate Expiration Date 4/10/2027
Facility Type Physician Office
Lab Director BRIAN G. WIDENHOUSE

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