18D2042628 CLIA NUMBER - AIR-EVAC 109

Laboratory Demographics

  • CLIA Code: 18D2042628
  • Facility Name: AIR-EVAC 109
  • Facility Address: 200 OLD TIMERS ROAD
    MANCHESTER, KY
    ZIP 40962
  • Facility Phone: 606 598-5513
  • Facility Type: Ambulance
  • Facility Type: Waiver
  • Lab Director: BRIAN A. JACKSON
  • NPI Number: 1265795728
  • Taxonomy: 3416A0800X - Ambulance

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CLIA Record

Field Name Field Value
CLIA Number 18D2042628
LAB Type Ambulance
Facility Name AIR-EVAC 109
Street 200 OLD TIMERS ROAD
City MANCHESTER
State KY
ZIP 40962
Phone 606 598-5513
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/15/2024
Certificate Expiration Date 6/14/2026
Facility Type Ambulance
Lab Director BRIAN A. JACKSON

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