24D2087504 CLIA NUMBER - INTERVENTIONAL SPINE AND PAIN PHYSICIANS, PA

Laboratory Demographics

  • CLIA Code: 24D2087504
  • Facility Name: INTERVENTIONAL SPINE AND PAIN PHYSICIANS, PA
  • Facility Address: 3000 HUNDERTMARK ROAD SUITE 250
    CHASKA, MN
    ZIP 55318
  • Facility Phone: 763 201-8191
  • Facility Type: Physician Office
  • Facility Type: Accreditation
  • Lab Director: DR. JUSTIN PELTOLA
  • NPI Number: 1326398561
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 24D2087504
LAB Type Physician Office
Facility Name INTERVENTIONAL SPINE AND PAIN PHYSICIANS, PA
Street 3000 HUNDERTMARK ROAD SUITE 250
City CHASKA
State MN
ZIP 55318
Phone 763 201-8191
Certificate Type Certificate of Accreditation
Certificate Type Description This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.
Certificate Effective Date 9/7/2024
Certificate Expiration Date 9/6/2026
Facility Type Physician Office
Lab Director DR. JUSTIN PELTOLA

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