15D2015110 CLIA NUMBER - KOKOMO PAIN MANAGEMENT, LLC

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Laboratory Demographics

CLIA Number: 15D2015110

Facility Name: KOKOMO PAIN MANAGEMENT, LLC

Facility Address:
18077 RIVER RD STE 200
NOBLESVILLE, IN
ZIP 46062
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Facility Phone Number: 317 776-7028

Facility Type: Physician Office

Certificate Type: Certificate of Compliance

NPI Number: 1568771095

Taxonomy: 261QP3300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	15D2015110
LAB Type	Physician Office
Facility Name	KOKOMO PAIN MANAGEMENT, LLC
Street	18077 RIVER RD STE 200
City	NOBLESVILLE
State	IN
ZIP	46062
Phone	317 776-7028
CertificateType	2
CertificateEffectiveDate	3/16/2023
CertificateExpirationDate	3/15/2025
FacilityType	Compliance

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