26D2020572 CLIA NUMBER - PAIN MANAGEMENT MEDICAL CENTER LLC DBA RESTORATIVE PAIN

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Laboratory Demographics

CLIA Number: 26D2020572

Facility Name: PAIN MANAGEMENT MEDICAL CENTER LLC DBA RESTORATIVE PAIN

Facility Address:
6829 PARKER ROAD SUITE A
FLORISSANT, MO
ZIP 63033
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Facility Phone Number: 314 741-2700

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1073784823

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	26D2020572
LAB Type	Physician Office
Facility Name	PAIN MANAGEMENT MEDICAL CENTER LLC DBA RESTORATIVE PAIN
Street	6829 PARKER ROAD SUITE A
City	FLORISSANT
State	MO
ZIP	63033
Phone	314 741-2700
CertificateType	4
CertificateEffectiveDate	1/1/2024
CertificateExpirationDate	12/31/2025
FacilityType	Waiver

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