04D1089068 CLIA NUMBER - AIR-EVAC 04

Laboratory Demographics

  • CLIA Code: 04D1089068
  • Facility Name: AIR-EVAC 04
  • Facility Address: 712 W MAPLE AVENUE
    SPRINGDALE, AR
    ZIP 72764
  • Facility Phone: 479 419-4904
  • Facility Type: Ambulance
  • Facility Type: Waiver
  • Lab Director: DOUG BAKER
  • NPI Number: 1598748394
  • Taxonomy: 3416A0800X - Ambulance

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CLIA Record

Field Name Field Value
CLIA Number 04D1089068
LAB Type Ambulance
Facility Name AIR-EVAC 04
Street 712 W MAPLE AVENUE
City SPRINGDALE
State AR
ZIP 72764
Phone 479 419-4904
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/10/2024
Certificate Expiration Date 9/9/2026
Facility Type Ambulance
Lab Director DOUG BAKER

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