14D2049796 CLIA NUMBER - INNOVATIVE PAIN SPECIALISTS L L C

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Laboratory Demographics

CLIA Number: 14D2049796

Facility Name: INNOVATIVE PAIN SPECIALISTS L L C

Facility Address:
2101 S ARLINGTON HEIGHTS RD, STE 165
ARLINGTON HEIGHTS, IL
ZIP 60005
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Facility Phone Number: 847 593-6800

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1225385131

Taxonomy: 332900000X - Non-Pharmacy Dispensing Site
A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.)

CLIA Record

Field Name	Field Value
CLIA Number	14D2049796
LAB Type	Physician Office
Facility Name	INNOVATIVE PAIN SPECIALISTS L L C
Street	2101 S ARLINGTON HEIGHTS RD, STE 165
City	ARLINGTON HEIGHTS
State	IL
ZIP	60005
Phone	847 593-6800
CertificateType	4
CertificateEffectiveDate	11/14/2022
CertificateExpirationDate	11/13/2024
FacilityType	Waiver

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