18D1087830 CLIA NUMBER - AIR-EVAC 79

Laboratory Demographics

CLIA Number: 18D1087830

Facility Name: AIR-EVAC 79

Facility Address:
620 TRILLIUM WAY
CORBIN, KY
ZIP 40701
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Facility Phone Number: 606 280-7379

Facility Type: Ambulance

Certificate Type: Waiver

NPI Number: 1720242829

Taxonomy: 3416A0800X - Ambulance

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
CertificateType	4
CertificateEffectiveDate	8/12/2022
CertificateExpirationDate	8/11/2024
FacilityType	Waiver

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