45D2280954 CLIA NUMBER - TEXAS PAIN INSTITUTE

Laboratory Demographics

CLIA Number: 45D2280954

Facility Name: TEXAS PAIN INSTITUTE

Facility Address:
110 MARY LOU DRIVE SUITE 100
WILLOW PARK, TX
ZIP 76087
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Facility Phone Number: 817 348-8600

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1447334305

Taxonomy: 261QP3300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	45D2280954
LAB Type	Physician Office
Facility Name	TEXAS PAIN INSTITUTE
Street	110 MARY LOU DRIVE SUITE 100
City	WILLOW PARK
State	TX
ZIP	76087
Phone	817 348-8600
CertificateType	4
CertificateEffectiveDate	4/28/2023
CertificateExpirationDate	4/27/2025
FacilityType	Waiver

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