44D2121168 CLIA NUMBER - ADVANCED DIAGNOSTIC IMAGING PC DBA THE PAIN MANAGEMENT GROUP

Laboratory Demographics

CLIA Number: 44D2121168

Facility Name: ADVANCED DIAGNOSTIC IMAGING PC DBA THE PAIN MANAGEMENT GROUP

Facility Address:
40 WEST CALDWELL STREET STE 200
MOUNT JULIET, TN
ZIP 37122
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Facility Phone Number: 615 941-8501

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1730321068

Taxonomy: 261QS1200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	44D2121168
LAB Type	Physician Office
Facility Name	ADVANCED DIAGNOSTIC IMAGING PC DBA THE PAIN MANAGEMENT GROUP
Street	40 WEST CALDWELL STREET STE 200
City	MOUNT JULIET
State	TN
ZIP	37122
Phone	615 941-8501
CertificateType	4
CertificateEffectiveDate	11/1/2022
CertificateExpirationDate	10/31/2024
FacilityType	Waiver

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