43D1039478 CLIA NUMBER - LAKESIDE PAIN CENTER PROF, LLC

Laboratory Demographics

  • CLIA Code: 43D1039478
  • Facility Name: LAKESIDE PAIN CENTER PROF, LLC
  • Facility Address: 1512 4TH STREET NE
    WATERTOWN, SD
    ZIP 57201
  • Facility Phone: 605 884-0100
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: AUSTIN BECK
  • NPI Number: 1184660151
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 43D1039478
LAB Type Physician Office
Facility Name LAKESIDE PAIN CENTER PROF, LLC
Street 1512 4TH STREET NE
City WATERTOWN
State SD
ZIP 57201
Phone 605 884-0100
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/14/2025
Certificate Expiration Date 4/13/2027
Facility Type Physician Office
Lab Director AUSTIN BECK

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