34D2149402 CLIA NUMBER - INTERVENTIONAL PAIN CENTERS, LLC

Laboratory Demographics

  • CLIA Code: 34D2149402
  • Facility Name: INTERVENTIONAL PAIN CENTERS, LLC
  • Facility Address: 2153 VALLEYGATE DRIVE, SUITE 102
    FAYETTEVILLE, NC
    ZIP 28304
  • Facility Phone: (910) 321-7246
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DOUGLAS WISOR
  • NPI Number: 1255877171
  • Taxonomy: 207LP2900X - Anesthesiology

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CLIA Record

Field Name Field Value
CLIA Number 34D2149402
LAB Type Physician Office
Facility Name INTERVENTIONAL PAIN CENTERS, LLC
Street 2153 VALLEYGATE DRIVE, SUITE 102
City FAYETTEVILLE
State NC
ZIP 28304
Phone 9103217246
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/4/2024
Certificate Expiration Date 6/3/2026
Facility Type Physician Office
Lab Director DOUGLAS WISOR

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This page was last updated on: 5/18/2026