03D2011744 CLIA NUMBER - TRIAD PAIN MANAGEMENT

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Laboratory Demographics

CLIA Number: 03D2011744

Facility Name: TRIAD PAIN MANAGEMENT

Facility Address:
2745 S ALMA SCHOOL RD, #2
CHANDLER, AZ
ZIP 85286
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Facility Phone Number: 480 413-0586

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1477802536

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	03D2011744
LAB Type	Physician Office
Facility Name	TRIAD PAIN MANAGEMENT
Street	2745 S ALMA SCHOOL RD, #2
City	CHANDLER
State	AZ
ZIP	85286
Phone	480 413-0586
CertificateType	4
CertificateEffectiveDate	8/23/2022
CertificateExpirationDate	8/22/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024