04D1089068 CLIA NUMBER - AIR-EVAC 04

Laboratory Demographics

CLIA Number: 04D1089068

Facility Name: AIR-EVAC 04

Facility Address:
712 W MAPLE AVENUE
SPRINGDALE, AR
ZIP 72764
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Facility Phone Number: 479 419-4904

Facility Type: Ambulance

Certificate Type: Waiver

NPI Number: 1598748394

Taxonomy: 3416A0800X - Ambulance

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
CertificateType	4
CertificateEffectiveDate	9/10/2022
CertificateExpirationDate	9/9/2024
FacilityType	Waiver

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