03D2013854 CLIA NUMBER - ADVANCED SPINE AND PAIN LLC

Laboratory Demographics

  • CLIA Code: 03D2013854
  • Facility Name: ADVANCED SPINE AND PAIN LLC
  • Facility Address: 2563 S VAL VISTA DR, STE 101
    GILBERT, AZ
    ZIP 85295
  • Facility Phone: 480 573-0130
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: JARRETT M. LEATHEM
  • NPI Number: 1689100299
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 03D2013854
LAB Type Ambulatory Surgery Center
Facility Name ADVANCED SPINE AND PAIN LLC
Street 2563 S VAL VISTA DR, STE 101
City GILBERT
State AZ
ZIP 85295
Phone 480 573-0130
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/24/2024
Certificate Expiration Date 9/23/2026
Facility Type Ambulatory Surgery Center
Lab Director JARRETT M. LEATHEM

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