19D1107672 CLIA NUMBER - PREMIER PAIN CENTER

Laboratory Demographics

CLIA Number: 19D1107672

Facility Name: PREMIER PAIN CENTER

Facility Address:
7015 HIGHWAY 190 EAST SERVICE ROAD, SUITE 201
COVINGTON, LA
ZIP 70433
Get Directions

Facility Phone Number: 985 809-1997

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1144734153

Taxonomy: 332900000X - Non-Pharmacy Dispensing Site
A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.)

CLIA Record

Field Name	Field Value
CLIA Number	19D1107672
LAB Type	Physician Office
Facility Name	PREMIER PAIN CENTER
Street	7015 HIGHWAY 190 EAST SERVICE ROAD, SUITE 201
City	COVINGTON
State	LA
ZIP	70433
Phone	985 809-1997
CertificateType	4
CertificateEffectiveDate	11/10/2023
CertificateExpirationDate	11/9/2025
FacilityType	Waiver

Download Record

Export to text format icon Download this CLIA NUMBER record in Text format: Export

Export to text format icon Download this CLIA NUMBER record in Excel (CSV) format: Export

Export to text format icon Download this CLIA NUMBER record in XML format: Export

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