03D2129837 CLIA NUMBER - SURPRISE PAIN MANAGEMENT

Laboratory Demographics

CLIA Number: 03D2129837

Facility Name: SURPRISE PAIN MANAGEMENT

Facility Address:
13697 W GRAND AVE STE C103
SURPRISE, AZ
ZIP 85374
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Facility Phone Number: (602) 589-0500

Facility Type: PHYSICIAN OFFICE

Certificate Type: Waiver

NPI Number: 1114462330

Taxonomy: 261QD0000X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	03D2129837
LAB Type	PHYSICIAN OFFICE
Facility Name	SURPRISE PAIN MANAGEMENT
Street	13697 W GRAND AVE STE C103
City	SURPRISE
State	AZ
ZIP	85374
Phone	(602) 589-0500

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This page was last updated on: 5/11/2023