15D1087918 CLIA NUMBER - AIR EVAC 17

Laboratory Demographics

  • CLIA Code: 15D1087918
  • Facility Name: AIR EVAC 17
  • Facility Address: 690 W HOSPITAL RD
    PAOLI, IN
    ZIP 47454
  • Facility Phone: 812 723-0157
  • Facility Type: Ambulance
  • Facility Type: Waiver
  • Lab Director: JOHN O. GOTT
  • NPI Number: 1013990191
  • Taxonomy: 3416A0800X - Ambulance

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CLIA Record

Field Name Field Value
CLIA Number 15D1087918
LAB Type Ambulance
Facility Name AIR EVAC 17
Street 690 W HOSPITAL RD
City PAOLI
State IN
ZIP 47454
Phone 812 723-0157
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/13/2024
Certificate Expiration Date 8/12/2026
Facility Type Ambulance
Lab Director JOHN O. GOTT

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