25D2041693 CLIA NUMBER - PREMIER PAIN CARE

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Laboratory Demographics

CLIA Number: 25D2041693

Facility Name: PREMIER PAIN CARE

Facility Address:
514 F EAST WOODROW WILSON AVENUE
JACKSON, MS
ZIP 39216
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Facility Phone Number: 601 982-3132

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1336408186

Taxonomy: 261QP3300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	25D2041693
LAB Type	Physician Office
Facility Name	PREMIER PAIN CARE
Street	514 F EAST WOODROW WILSON AVENUE
City	JACKSON
State	MS
ZIP	39216
Phone	601 982-3132
CertificateType	4
CertificateEffectiveDate	5/29/2022
CertificateExpirationDate	5/28/2024
FacilityType	Waiver

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