26D2015380 CLIA NUMBER - PRO PAIN, LLC

Laboratory Demographics

  • CLIA Code: 26D2015380
  • Facility Name: PRO PAIN, LLC
  • Facility Address: 1055 BOWLES AVE
    FENTON, MO
    ZIP 63026
  • Facility Phone: 636 496-3900
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MICHAEL BOEDEFELD
  • NPI Number: 1689947202
  • Taxonomy: 261QP3300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 26D2015380
LAB Type Physician Office
Facility Name PRO PAIN, LLC
Street 1055 BOWLES AVE
City FENTON
State MO
ZIP 63026
Phone 636 496-3900
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/26/2024
Certificate Expiration Date 10/25/2026
Facility Type Physician Office
Lab Director MICHAEL BOEDEFELD

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