10D1074337 CLIA NUMBER - SPINE AND PAIN MEDICINE CTR

Laboratory Demographics

CLIA Number: 10D1074337

Facility Name: SPINE AND PAIN MEDICINE CTR

Facility Address:
8811 S R 52 STE 21
HUDSON, FL
ZIP 34667
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Facility Phone Number: 727 861-2277

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1609051150

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	10D1074337
LAB Type	Physician Office
Facility Name	SPINE AND PAIN MEDICINE CTR
Street	8811 S R 52 STE 21
City	HUDSON
State	FL
ZIP	34667
Phone	727 861-2277
CertificateType	4
CertificateEffectiveDate	9/26/2023
CertificateExpirationDate	9/25/2025
FacilityType	Waiver

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