34D2085408 CLIA NUMBER - INTERVENTIONAL PAIN CENTER PLLC

Laboratory Demographics

  • CLIA Code: 34D2085408
  • Facility Name: INTERVENTIONAL PAIN CENTER PLLC
  • Facility Address: 4320 FAYETTEVILLE ROAD, SUITE A
    LUMBERTON, NC
    ZIP 28358
  • Facility Phone: 910 738-9599
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DOUGLAS WISOR
  • NPI Number: 1790220408
  • Taxonomy: 207LP2900X - Anesthesiology

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CLIA Record

Field Name Field Value
CLIA Number 34D2085408
LAB Type Physician Office
Facility Name INTERVENTIONAL PAIN CENTER PLLC
Street 4320 FAYETTEVILLE ROAD, SUITE A
City LUMBERTON
State NC
ZIP 28358
Phone 910 738-9599
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/14/2024
Certificate Expiration Date 10/13/2026
Facility Type Physician Office
Lab Director DOUGLAS WISOR

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