14D2168380 CLIA NUMBER - AIR EVAC LIFETEAM - A E L 156

Laboratory Demographics

CLIA Number: 14D2168380

Facility Name: AIR EVAC LIFETEAM - A E L 156

Facility Address:
2181 VADALABENE DR
MARYVILLE, IL
ZIP 62062
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Facility Phone Number: 618 306-4198

Facility Type: Mobile Laboratory

Certificate Type: Waiver

NPI Number: 1114490455

Taxonomy: 3416A0800X - Ambulance

CLIA Record

Field Name	Field Value
CLIA Number	14D2168380
LAB Type	Mobile Laboratory
Facility Name	AIR EVAC LIFETEAM - A E L 156
Street	2181 VADALABENE DR
City	MARYVILLE
State	IL
ZIP	62062
Phone	618 306-4198
CertificateType	4
CertificateEffectiveDate	6/27/2023
CertificateExpirationDate	6/26/2025
FacilityType	Waiver

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