14D1089533 CLIA NUMBER - MEDICAL PAIN MANAGEMENT SERVICES LTD

Laboratory Demographics

CLIA Number: 14D1089533

Facility Name: MEDICAL PAIN MANAGEMENT SERVICES LTD

Facility Address:
1235 NORTH MULFORD ROAD SUITE 222
ROCKFORD, IL
ZIP 61107
Get Directions

Facility Phone Number: 815 397-8400

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1447276480

Taxonomy: 261QP3300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D1089533
LAB Type	Physician Office
Facility Name	MEDICAL PAIN MANAGEMENT SERVICES LTD
Street	1235 NORTH MULFORD ROAD SUITE 222
City	ROCKFORD
State	IL
ZIP	61107
Phone	815 397-8400
CertificateType	4
CertificateEffectiveDate	9/19/2022
CertificateExpirationDate	9/18/2024
FacilityType	Waiver

Download Record

Export to text format icon Download this CLIA NUMBER record in Text format: Export

Export to text format icon Download this CLIA NUMBER record in Excel (CSV) format: Export

Export to text format icon Download this CLIA NUMBER record in XML format: Export

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