26D2103952 CLIA NUMBER - KC PAIN ASC, LLC DBA MIDWEST PAIN MANAGEMENT CENTER

Laboratory Demographics

CLIA Number: 26D2103952

Facility Name: KC PAIN ASC, LLC DBA MIDWEST PAIN MANAGEMENT CENTER

Facility Address:
200 NE MISSOURI ROAD SUITE 100
LEES SUMMIT, MO
ZIP 64086
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Facility Phone Number: 816 282-5370

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1487039517

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	26D2103952
LAB Type	Ambulatory Surgery Center
Facility Name	KC PAIN ASC, LLC DBA MIDWEST PAIN MANAGEMENT CENTER
Street	200 NE MISSOURI ROAD SUITE 100
City	LEES SUMMIT
State	MO
ZIP	64086
Phone	816 282-5370
CertificateType	4
CertificateEffectiveDate	10/23/2023
CertificateExpirationDate	10/22/2025
FacilityType	Waiver

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