03D2220283 CLIA NUMBER - FIRST MOBILE LAB SERVICE LLC

Laboratory Demographics

  • CLIA Code: 03D2220283
  • Facility Name: FIRST MOBILE LAB SERVICE LLC
  • Facility Address: 3054 SHOSHONE DR STE 104
    LAKE HAVASU CITY, AZ
    ZIP 86406
  • Facility Phone: 928 486-5370
  • Facility Type: Mobile Laboratory
  • Facility Type: Waiver
  • Lab Director: SANDRA L. ULMER
  • NPI Number: 1588241822
  • Taxonomy: 246RP1900X - Technician, Pathology

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CLIA Record

Field Name Field Value
CLIA Number 03D2220283
LAB Type Mobile Laboratory
Facility Name FIRST MOBILE LAB SERVICE LLC
Street 3054 SHOSHONE DR STE 104
City LAKE HAVASU CITY
State AZ
ZIP 86406
Phone 928 486-5370
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/12/2025
Certificate Expiration Date 4/11/2027
Facility Type Mobile Laboratory
Lab Director SANDRA L. ULMER

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