10D2092037 CLIA NUMBER - INTERVENTIONAL PAIN SPECIALISTS OF SOUTHWEST FLORIDA

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Laboratory Demographics

CLIA Number: 10D2092037

Facility Name: INTERVENTIONAL PAIN SPECIALISTS OF SOUTHWEST FLORIDA

Facility Address:
10730 KETCHUM VALLEY DR
RIVERVIEW, FL
ZIP 33579
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Facility Phone Number: 813 331-4465

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1205249026

Taxonomy: 208VP0014X - Pain Medicine
Interventional Pain Medicine is the discipline of medicine devoted to the diagnosis and treatment of pain and related disorders principally with the application of interventional techniques in managing subacute, chronic, persistent, and intractable pain, independently or in conjunction with other modalities of treatment.

CLIA Record

Field Name	Field Value
CLIA Number	10D2092037
LAB Type	Physician Office
Facility Name	INTERVENTIONAL PAIN SPECIALISTS OF SOUTHWEST FLORIDA
Street	10730 KETCHUM VALLEY DR
City	RIVERVIEW
State	FL
ZIP	33579
Phone	813 331-4465
CertificateType	4
CertificateEffectiveDate	2/25/2023
CertificateExpirationDate	2/24/2025
FacilityType	Waiver

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