20D2167012 CLIA NUMBER - JACKMAN-MOOSE RIVER FIRE & RESCUE DEPT

Laboratory Demographics

  • CLIA Code: 20D2167012
  • Facility Name: JACKMAN-MOOSE RIVER FIRE & RESCUE DEPT
  • Facility Address: 369 MAIN STREET
    JACKMAN, ME
    ZIP 04945
  • Facility Phone: 207 668-2111
  • Facility Type: Ambulance
  • Facility Type: Waiver
  • Lab Director: MICHAEL P. ST PETER
  • NPI Number: 1407375777
  • Taxonomy: 3416L0300X - Ambulance

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CLIA Record

Field Name Field Value
CLIA Number 20D2167012
LAB Type Ambulance
Facility Name JACKMAN-MOOSE RIVER FIRE & RESCUE DEPT
Street 369 MAIN STREET
City JACKMAN
State ME
ZIP 04945
Phone 207 668-2111
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/31/2025
Certificate Expiration Date 5/30/2027
Facility Type Ambulance
Lab Director MICHAEL P. ST PETER

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