25D1087819 CLIA NUMBER - AIR-EVAC 58

Laboratory Demographics

  • CLIA Code: 25D1087819
  • Facility Name: AIR-EVAC 58
  • Facility Address: 3704 JOANN DRIVE
    CORINTH, MS
    ZIP 38834
  • Facility Phone: 662 286-2708
  • Facility Type: Ambulance
  • Facility Type: Waiver
  • Lab Director: GARY JOHNSON
  • NPI Number: 1366425282
  • Taxonomy: 3416A0800X - Ambulance

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CLIA Record

Field Name Field Value
CLIA Number 25D1087819
LAB Type Ambulance
Facility Name AIR-EVAC 58
Street 3704 JOANN DRIVE
City CORINTH
State MS
ZIP 38834
Phone 662 286-2708
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 GARY JOHNSON

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