14D1088064 CLIA NUMBER - AIR EVAC 011 AIR EVAC EMS INC

Laboratory Demographics

  • CLIA Code: 14D1088064
  • Facility Name: AIR EVAC 011 AIR EVAC EMS INC
  • Facility Address: 500 FIREBAUGH DR - STE A
    MOUNT VERNON, IL
    ZIP 62864
  • Facility Phone: 618 315-2676
  • Facility Type: Mobile Laboratory
  • Facility Type: Waiver
  • Lab Director: DERRICK GAITHER
  • NPI Number: 1790768505
  • Taxonomy: 3416A0800X - Ambulance

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CLIA Record

Field Name Field Value
CLIA Number 14D1088064
LAB Type Mobile Laboratory
Facility Name AIR EVAC 011 AIR EVAC EMS INC
Street 500 FIREBAUGH DR - STE A
City MOUNT VERNON
State IL
ZIP 62864
Phone 618 315-2676
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/15/2024
Certificate Expiration Date 8/14/2026
Facility Type Mobile Laboratory
Lab Director DERRICK GAITHER

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