18D1087830 CLIA NUMBER - AIR-EVAC 79

Laboratory Demographics

  • CLIA Code: 18D1087830
  • Facility Name: AIR-EVAC 79
  • Facility Address: 620 TRILLIUM WAY
    CORBIN, KY
    ZIP 40701
  • Facility Phone: 606 280-7379
  • Facility Type: Ambulance
  • Facility Type: Waiver
  • Lab Director: JOE D. BRADSHAW
  • NPI Number: 1720242829
  • Taxonomy: 3416A0800X - Ambulance

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CLIA Record

Field Name Field Value
CLIA Number 18D1087830
LAB Type Ambulance
Facility Name AIR-EVAC 79
Street 620 TRILLIUM WAY
City CORBIN
State KY
ZIP 40701
Phone 606 280-7379
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/12/2024
Certificate Expiration Date 8/11/2026
Facility Type Ambulance
Lab Director JOE D. BRADSHAW

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This page was last updated on: 3/20/2025