03D0883517 CLIA NUMBER - RIVER MEDICAL INC

Laboratory Demographics

CLIA Number: 03D0883517

Facility Name: RIVER MEDICAL INC

Facility Address:
415 EL CAMINO WAY
LAKE HAVASU CITY, AZ
ZIP 86403
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Facility Phone Number: 928 855-4104

Facility Type: Other

Certificate Type: Waiver

NPI Number: 1316944846

Taxonomy: 3416L0300X - Ambulance

CLIA Record

Field Name	Field Value
CLIA Number	03D0883517
LAB Type	Other
Facility Name	RIVER MEDICAL INC
Street	415 EL CAMINO WAY
City	LAKE HAVASU CITY
State	AZ
ZIP	86403
Phone	928 855-4104
CertificateType	4
CertificateEffectiveDate	3/9/2024
CertificateExpirationDate	3/8/2026
FacilityType	Waiver

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