03D1040843 CLIA NUMBER - WHITE MOUNTAIN AMBULANCE SERVICE INC

Laboratory Demographics

CLIA Number: 03D1040843

Facility Name: WHITE MOUNTAIN AMBULANCE SERVICE INC

Facility Address:
118 S MOUNTAIN AVE
SPRINGERVILLE, AZ
ZIP 85938
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Facility Phone Number: 928 333-4202

Facility Type: Ambulance

Certificate Type: Waiver

NPI Number: 1598292377

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	03D1040843
LAB Type	Ambulance
Facility Name	WHITE MOUNTAIN AMBULANCE SERVICE INC
Street	118 S MOUNTAIN AVE
City	SPRINGERVILLE
State	AZ
ZIP	85938
Phone	928 333-4202
CertificateType	4
CertificateEffectiveDate	5/18/2023
CertificateExpirationDate	5/17/2025
FacilityType	Waiver

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