10D2131659 CLIA NUMBER - PORT ST LUCIE PAIN & MEDICAL INSTITUTE

Laboratory Demographics

CLIA Number: 10D2131659

Facility Name: PORT ST LUCIE PAIN & MEDICAL INSTITUTE

Facility Address:
4401 N ANDREWS AVENUE
OAKLAND PARK, FL
ZIP 33309
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Facility Phone Number: 954 900-4686

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1184307456

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	10D2131659
LAB Type	Physician Office
Facility Name	PORT ST LUCIE PAIN & MEDICAL INSTITUTE
Street	4401 N ANDREWS AVENUE
City	OAKLAND PARK
State	FL
ZIP	33309
Phone	954 900-4686
CertificateType	4
CertificateEffectiveDate	6/5/2023
CertificateExpirationDate	6/4/2025
FacilityType	Waiver

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