42D1094073 CLIA NUMBER - CAROLINAS CENTER FOR ADV MGMT OF PAIN

Laboratory Demographics

CLIA Number: 42D1094073

Facility Name: CAROLINAS CENTER FOR ADV MGMT OF PAIN

Facility Address:
279 E KENNEDY STREET
SPARTANBURG, SC
ZIP 29302
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Facility Phone Number: 803 791-7175

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1992259139

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	42D1094073
LAB Type	Physician Office
Facility Name	CAROLINAS CENTER FOR ADV MGMT OF PAIN
Street	279 E KENNEDY STREET
City	SPARTANBURG
State	SC
ZIP	29302
Phone	803 791-7175
CertificateType	4
CertificateEffectiveDate	1/9/2023
CertificateExpirationDate	1/8/2025
FacilityType	Waiver

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