14D2240811 CLIA NUMBER - JACKSON COUNTY AMBULANCE SERVICE

Laboratory Demographics

CLIA Number: 14D2240811

Facility Name: JACKSON COUNTY AMBULANCE SERVICE

Facility Address:
520 N UNIVERSITY AVE
CARBONDALE, IL
ZIP 62901
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Facility Phone Number: 618 529-5158

Facility Type: Ambulance

Certificate Type: Waiver

NPI Number: 1437260528

Taxonomy: 3416L0300X - Ambulance

CLIA Record

Field Name	Field Value
CLIA Number	14D2240811
LAB Type	Ambulance
Facility Name	JACKSON COUNTY AMBULANCE SERVICE
Street	520 N UNIVERSITY AVE
City	CARBONDALE
State	IL
ZIP	62901
Phone	618 529-5158
CertificateType	4
CertificateEffectiveDate	10/22/2023
CertificateExpirationDate	10/21/2025
FacilityType	Waiver

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