03D2137702 CLIA NUMBER - INTEGRATED PAIN CONSULTANTS

Laboratory Demographics

CLIA Number: 03D2137702

Facility Name: INTEGRATED PAIN CONSULTANTS

Facility Address:
4838 E BASELINE RD, BLDG 2, STE 109
MESA, AZ
ZIP 85206
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Facility Phone Number: 480 626-2552

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1538612965

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	03D2137702
LAB Type	Physician Office
Facility Name	INTEGRATED PAIN CONSULTANTS
Street	4838 E BASELINE RD, BLDG 2, STE 109
City	MESA
State	AZ
ZIP	85206
Phone	480 626-2552
CertificateType	4
CertificateEffectiveDate	10/2/2023
CertificateExpirationDate	10/1/2025
FacilityType	Waiver

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