14D0692412 CLIA NUMBER - SUPERIOR AIR GROUND AMBULANCE SERVICE

Laboratory Demographics

CLIA Number: 14D0692412

Facility Name: SUPERIOR AIR GROUND AMBULANCE SERVICE

Facility Address:
395 W LAKE STREET
ELMHURST, IL
ZIP 60126
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Facility Phone Number: 630 832-0923

Facility Type: Other

Certificate Type: Waiver

NPI Number: 1518558063

Taxonomy: 3416A0800X - Ambulance

CLIA Record

Field Name	Field Value
CLIA Number	14D0692412
LAB Type	Other
Facility Name	SUPERIOR AIR GROUND AMBULANCE SERVICE
Street	395 W LAKE STREET
City	ELMHURST
State	IL
ZIP	60126
Phone	630 832-0923
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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