17D0978026 CLIA NUMBER - MOUNDRIDGE EMS

Laboratory Demographics

CLIA Number: 17D0978026

Facility Name: MOUNDRIDGE EMS

Facility Address:
225 N WEDEL
MOUNDRIDGE, KS
ZIP 67107
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Facility Phone Number: 620 345-3657

Facility Type: Ambulance

Certificate Type: Waiver

NPI Number: 1174679906

Taxonomy: 3416L0300X - Ambulance

CLIA Record

Field Name	Field Value
CLIA Number	17D0978026
LAB Type	Ambulance
Facility Name	MOUNDRIDGE EMS
Street	225 N WEDEL
City	MOUNDRIDGE
State	KS
ZIP	67107
Phone	620 345-3657
CertificateType	4
CertificateEffectiveDate	11/17/2023
CertificateExpirationDate	11/16/2025
FacilityType	Waiver

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