03D2048793 CLIA NUMBER - PANACEA BRAIN AND SPINE LLC

Laboratory Demographics

  • CLIA Code: 03D2048793
  • Facility Name: PANACEA BRAIN AND SPINE LLC
  • Facility Address: 72 LAKE HAVASU AVE S STE 102
    LAKE HAVASU, AZ
    ZIP 86403
  • Facility Phone: 928 453-2211
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CHAD E. HARTLEY
  • NPI Number: 1457622763
  • Taxonomy: 207T00000X - Neurological Surgery

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CLIA Record

Field Name Field Value
CLIA Number 03D2048793
LAB Type Physician Office
Facility Name PANACEA BRAIN AND SPINE LLC
Street 72 LAKE HAVASU AVE S STE 102
City LAKE HAVASU
State AZ
ZIP 86403
Phone 928 453-2211
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/23/2024
Certificate Expiration Date 10/22/2026
Facility Type Physician Office
Lab Director CHAD E. HARTLEY

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