14D2117584 CLIA NUMBER - AIR EVAC LIFETEAM AEL 138 (DBA) AIR EVAC EMS INC

Laboratory Demographics

  • CLIA Code: 14D2117584
  • Facility Name: AIR EVAC LIFETEAM AEL 138 (DBA) AIR EVAC EMS INC
  • Facility Address: 177 VINCE ASHLEY DRIVE
    HARRISBURG, IL
    ZIP 62946
  • Facility Phone: 618 252-5290
  • Facility Type: Mobile Laboratory
  • Facility Type: Waiver
  • Lab Director: JUSTIN WOODALL
  • NPI Number: 1770036436
  • Taxonomy: 3416A0800X - Ambulance

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CLIA Record

Field Name Field Value
CLIA Number 14D2117584
LAB Type Mobile Laboratory
Facility Name AIR EVAC LIFETEAM AEL 138 (DBA) AIR EVAC EMS INC
Street 177 VINCE ASHLEY DRIVE
City HARRISBURG
State IL
ZIP 62946
Phone 618 252-5290
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/19/2024
Certificate Expiration Date 8/18/2026
Facility Type Mobile Laboratory
Lab Director JUSTIN WOODALL

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