10D2171446 CLIA NUMBER - SOUTHERN INTERVENTIONAL PAIN CENTER

Laboratory Demographics

  • CLIA Code: 10D2171446
  • Facility Name: SOUTHERN INTERVENTIONAL PAIN CENTER
  • Facility Address: 619 SW BAYA DR STE 102
    LAKE CITY, FL
    ZIP 32025
  • Facility Phone: 386 361-3400
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KAREN D. GIDDENS
  • NPI Number: 1063971596
  • Taxonomy: 208VP0014X - Pain Medicine

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CLIA Record

Field Name Field Value
CLIA Number 10D2171446
LAB Type Physician Office
Facility Name SOUTHERN INTERVENTIONAL PAIN CENTER
Street 619 SW BAYA DR STE 102
City LAKE CITY
State FL
ZIP 32025
Phone 386 361-3400
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/30/2025
Certificate Expiration Date 8/29/2027
Facility Type Physician Office
Lab Director KAREN D. GIDDENS

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This page was last updated on: 9/29/2025