05D2116047 CLIA NUMBER - PHI AIR MEDICAL, L.L.C.

Laboratory Demographics

  • CLIA Code: 05D2116047
  • Facility Name: PHI AIR MEDICAL, L.L.C.
  • Facility Address: 801-D AIRPORT WAY
    MODESTO, CA
    ZIP 95354
  • Facility Phone: 209 968-4360
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: ROBERT A. DONOVAN, MD
  • NPI Number: 1780925990
  • Taxonomy: 3416A0800X - Ambulance

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CLIA Record

Field Name Field Value
CLIA Number 05D2116047
LAB Type Ambulatory Surgery Center
Facility Name PHI AIR MEDICAL, L.L.C.
Street 801-D AIRPORT WAY
City MODESTO
State CA
ZIP 95354
Phone 209 968-4360
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/18/2024
Certificate Expiration Date 7/17/2026
Facility Type Ambulatory Surgery Center
Lab Director ROBERT A. DONOVAN, MD

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This page was last updated on: 6/4/2025