14D2177392 CLIA NUMBER - MILLENNIUM PAIN CENTER, L L C

Laboratory Demographics

CLIA Number: 14D2177392

Facility Name: MILLENNIUM PAIN CENTER, L L C

Facility Address:
2406 E EMPIRE ST
BLOOMINGTON, IL
ZIP 61704
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Facility Phone Number: 309 662-4321

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1225196488

Taxonomy: 261QP3300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D2177392
LAB Type	Physician Office
Facility Name	MILLENNIUM PAIN CENTER, L L C
Street	2406 E EMPIRE ST
City	BLOOMINGTON
State	IL
ZIP	61704
Phone	309 662-4321
CertificateType	4
CertificateEffectiveDate	1/9/2024
CertificateExpirationDate	1/8/2026
FacilityType	Waiver

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