53D2114603 CLIA NUMBER - A WYOMING PAIN CLINIC PC

Laboratory Demographics

CLIA Number: 53D2114603

Facility Name: A WYOMING PAIN CLINIC PC

Facility Address:
3100 WEST LAKEWAY RD STE 3
GILLETTE, WY
ZIP 82718
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Facility Phone Number: 307 696-2996

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1164804480

Taxonomy: 207LP2900X - Anesthesiology
An anesthesiologist who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic and/or cancer pain in both hospital and ambulatory settings. Patient care needs are also coordinated with other specialists.

CLIA Record

Field Name	Field Value
CLIA Number	53D2114603
LAB Type	Physician Office
Facility Name	A WYOMING PAIN CLINIC PC
Street	3100 WEST LAKEWAY RD STE 3
City	GILLETTE
State	WY
ZIP	82718
Phone	307 696-2996
CertificateType	4
CertificateEffectiveDate	6/17/2022
CertificateExpirationDate	6/16/2024
FacilityType	Waiver

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