14D2129780 CLIA NUMBER - AIR EVAC LIFETEAM

Laboratory Demographics

  • CLIA Code: 14D2129780
  • Facility Name: AIR EVAC LIFETEAM
  • Facility Address: 529 E GRANT ST
    MACOMB, IL
    ZIP 61455
  • Facility Phone: 217 209-2311
  • Facility Type: Mobile Laboratory
  • Facility Type: Waiver
  • Lab Director: TAMMY WIEMELT
  • NPI Number: 1417481912
  • Taxonomy: 3416A0800X - Ambulance

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 14D2129780
LAB Type Mobile Laboratory
Facility Name AIR EVAC LIFETEAM
Street 529 E GRANT ST
City MACOMB
State IL
ZIP 61455
Phone 217 209-2311
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/25/2025
Certificate Expiration Date 4/24/2027
Facility Type Mobile Laboratory
Lab Director TAMMY WIEMELT

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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