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

Laboratory Demographics

  • CLIA Code: 14D2168380
  • Facility Name: AIR EVAC LIFETEAM - A E L 156
  • Facility Address: 2181 VADALABENE DR
    MARYVILLE, IL
    ZIP 62062
  • Facility Phone: 618 306-4198
  • Facility Type: Mobile Laboratory
  • Facility Type: Waiver
  • Lab Director: TRACEY SWABBY
  • NPI Number: 1114490455
  • Taxonomy: 3416A0800X - Ambulance

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/27/2025
Certificate Expiration Date 6/26/2027
Facility Type Mobile Laboratory
Lab Director TRACEY SWABBY

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