24D2082934 CLIA NUMBER - JACKSON VOLUNTEER AMBULANCE SERVICE

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Laboratory Demographics

CLIA Number: 24D2082934

Facility Name: JACKSON VOLUNTEER AMBULANCE SERVICE

Facility Address:
305 SHERIDAN STREET
JACKSON, MN
ZIP 56143
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Facility Phone Number: 507 847-5306

Facility Type: Ambulance

Certificate Type: Waiver

NPI Number: 1811915648

Taxonomy: 3416L0300X - Ambulance

CLIA Record

Field Name	Field Value
CLIA Number	24D2082934
LAB Type	Ambulance
Facility Name	JACKSON VOLUNTEER AMBULANCE SERVICE
Street	305 SHERIDAN STREET
City	JACKSON
State	MN
ZIP	56143
Phone	507 847-5306
CertificateType	4
CertificateEffectiveDate	8/26/2022
CertificateExpirationDate	8/25/2024
FacilityType	Waiver

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