04D1089082 CLIA NUMBER - AIR-EVAC 42

Laboratory Demographics

  • CLIA Code: 04D1089082
  • Facility Name: AIR-EVAC 42
  • Facility Address: 1000 HOLIDAY DRIVE
    FORREST CITY, AR
    ZIP 72335
  • Facility Phone: 870 630-9194
  • Facility Type: Ambulance
  • Facility Type: Waiver
  • Lab Director: TODD COLLUMS
  • NPI Number: 1225011042
  • Taxonomy: 3416A0800X - Ambulance

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CLIA Record

Field Name Field Value
CLIA Number 04D1089082
LAB Type Ambulance
Facility Name AIR-EVAC 42
Street 1000 HOLIDAY DRIVE
City FORREST CITY
State AR
ZIP 72335
Phone 870 630-9194
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 TODD COLLUMS

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