18D2149027 CLIA NUMBER - KENTUCKIANA PAIN SPECIALIST AMBULATORY SURGERY CENTER

Laboratory Demographics

CLIA Number: 18D2149027

Facility Name: KENTUCKIANA PAIN SPECIALIST AMBULATORY SURGERY CENTER

Facility Address:
3710 CHAMBERLAIN LANE, STE B
LOUISVILLE, KY
ZIP 40241
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Facility Phone Number: 502 995-4004

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1295311058

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name	Field Value
CLIA Number	18D2149027
LAB Type	Ambulatory Surgery Center
Facility Name	KENTUCKIANA PAIN SPECIALIST AMBULATORY SURGERY CENTER
Street	3710 CHAMBERLAIN LANE, STE B
City	LOUISVILLE
State	KY
ZIP	40241
Phone	502 995-4004
CertificateType	4
CertificateEffectiveDate	5/23/2022
CertificateExpirationDate	5/22/2024
FacilityType	Waiver

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