18D2167064 CLIA NUMBER - COMMONWEALTH PAIN ASSOCIATES PLLC

Laboratory Demographics

CLIA Number: 18D2167064

Facility Name: COMMONWEALTH PAIN ASSOCIATES PLLC

Facility Address:
225 EXECUTIVE PARK
LOUISVILLE, KY
ZIP 40207
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Facility Phone Number: 502 409-9925

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1295395341

Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies
A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.

CLIA Record

Field Name	Field Value
CLIA Number	18D2167064
LAB Type	Physician Office
Facility Name	COMMONWEALTH PAIN ASSOCIATES PLLC
Street	225 EXECUTIVE PARK
City	LOUISVILLE
State	KY
ZIP	40207
Phone	502 409-9925
CertificateType	4
CertificateEffectiveDate	5/31/2023
CertificateExpirationDate	5/30/2025
FacilityType	Waiver

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