03D1033456 CLIA NUMBER - BLUE RIDGE FIRE DEPARTMENT

Laboratory Demographics

  • CLIA Code: 03D1033456
  • Facility Name: BLUE RIDGE FIRE DEPARTMENT
  • Facility Address: 5023 ENCHANTED LN
    HAPPY JACK, AZ
    ZIP 86024
  • Facility Phone: 928 477-2751
  • Facility Type: Other
  • Facility Type: Waiver
  • Lab Director: JOHN BANNING
  • NPI Number: 1689721367
  • Taxonomy: 3416L0300X - Ambulance

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CLIA Record

Field Name Field Value
CLIA Number 03D1033456
LAB Type Other
Facility Name BLUE RIDGE FIRE DEPARTMENT
Street 5023 ENCHANTED LN
City HAPPY JACK
State AZ
ZIP 86024
Phone 928 477-2751
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/9/2024
Certificate Expiration Date 11/8/2026
Facility Type Other
Lab Director JOHN BANNING

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This page was last updated on: 9/29/2025