02D0895547 CLIA NUMBER - FAIRBANKS NORTH STAR BOROUGH EMERGENCY MANAGEMENT

Laboratory Demographics

CLIA Number: 02D0895547

Facility Name: FAIRBANKS NORTH STAR BOROUGH EMERGENCY MANAGEMENT

Facility Address:
3175 PEGER ROAD
FAIRBANKS, AK
ZIP 99709
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Facility Phone Number: 907 459-1481

Facility Type: Mobile Laboratory

Certificate Type: Waiver

NPI Number: 1720039076

Taxonomy: 3416L0300X - Ambulance

CLIA Record

Field Name	Field Value
CLIA Number	02D0895547
LAB Type	Mobile Laboratory
Facility Name	FAIRBANKS NORTH STAR BOROUGH EMERGENCY MANAGEMENT
Street	3175 PEGER ROAD
City	FAIRBANKS
State	AK
ZIP	99709
Phone	907 459-1481
CertificateType	4
CertificateEffectiveDate	12/12/2022
CertificateExpirationDate	12/11/2024
FacilityType	Waiver

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