14D0907699 CLIA NUMBER - GIBSON AREA AMBULANCE SERVICE

Laboratory Demographics

CLIA Number: 14D0907699

Facility Name: GIBSON AREA AMBULANCE SERVICE

Facility Address:
1120 NORTH MELVIN
GIBSON CITY, IL
ZIP 60936
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Facility Phone Number: 217 784-2228

Facility Type: Mobile Laboratory

Certificate Type: Waiver

NPI Number: 1306854179

Taxonomy: 3416L0300X - Ambulance

CLIA Record

Field Name	Field Value
CLIA Number	14D0907699
LAB Type	Mobile Laboratory
Facility Name	GIBSON AREA AMBULANCE SERVICE
Street	1120 NORTH MELVIN
City	GIBSON CITY
State	IL
ZIP	60936
Phone	217 784-2228
CertificateType	4
CertificateEffectiveDate	10/19/2023
CertificateExpirationDate	10/18/2025
FacilityType	Waiver

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