15D2001084 CLIA NUMBER - MIDWEST PAIN CLINIC INTERVENTIONAL

Laboratory Demographics

  • CLIA Code: 15D2001084
  • Facility Name: MIDWEST PAIN CLINIC INTERVENTIONAL
  • Facility Address: 350 COMMERCE SQUARE
    MICHIGAN CITY, IN
    ZIP 46360
  • Facility Phone: 219 872-9158
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: PAUL MADISON
  • NPI Number: 1548696446
  • Taxonomy: 261QP3300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 15D2001084
LAB Type Physician Office
Facility Name MIDWEST PAIN CLINIC INTERVENTIONAL
Street 350 COMMERCE SQUARE
City MICHIGAN CITY
State IN
ZIP 46360
Phone 219 872-9158
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/23/2025
Certificate Expiration Date 4/22/2027
Facility Type Physician Office
Lab Director PAUL MADISON

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