17D1004263 CLIA NUMBER - JACKSON COUNTY EMS

Laboratory Demographics

  • CLIA Code: 17D1004263
  • Facility Name: JACKSON COUNTY EMS
  • Facility Address: 300 W 4TH ST
    HOLTON, KS
    ZIP 66436
  • Facility Phone: 785 364-1911
  • Facility Type: Ambulance
  • Facility Type: Waiver
  • Lab Director: BRENT W. TETER
  • NPI Number: 1184628455
  • Taxonomy: 3416L0300X - Ambulance

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CLIA Record

Field Name Field Value
CLIA Number 17D1004263
LAB Type Ambulance
Facility Name JACKSON COUNTY EMS
Street 300 W 4TH ST
City HOLTON
State KS
ZIP 66436
Phone 785 364-1911
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/23/2024
Certificate Expiration Date 9/22/2026
Facility Type Ambulance
Lab Director BRENT W. TETER

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