26D2082543 CLIA NUMBER - BLACK JACK FIRE PROTECTION DISTRICT

Laboratory Demographics

  • CLIA Code: 26D2082543
  • Facility Name: BLACK JACK FIRE PROTECTION DISTRICT
  • Facility Address: 5675 NORTH HIGHWAY 67
    FLORISSANT, MO
    ZIP 63034
  • Facility Phone: 314 741-9905
  • Facility Type: Other - FIRE PROTECTION DIST
  • Facility Type: Waiver
  • Lab Director: ROGER A. ELLISON
  • NPI Number: 1043091176
  • Taxonomy: 3416L0300X - Ambulance

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CLIA Record

Field Name Field Value
CLIA Number 26D2082543
LAB Type Other - FIRE PROTECTION DIST
Facility Name BLACK JACK FIRE PROTECTION DISTRICT
Street 5675 NORTH HIGHWAY 67
City FLORISSANT
State MO
ZIP 63034
Phone 314 741-9905
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/20/2024
Certificate Expiration Date 1/19/2026
Facility Type Other - FIRE PROTECTION DIST
Lab Director ROGER A. ELLISON

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