27D2102028 CLIA NUMBER - MISSOULA EMERGENCY SERVICE

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Laboratory Demographics

CLIA Number: 27D2102028

Facility Name: MISSOULA EMERGENCY SERVICE

Facility Address:
2680 PALMER ST
MISSOULA, MT
ZIP 59808
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Facility Phone Number: 406 549-2325

Facility Type: Ambulance

Certificate Type: Waiver

NPI Number: 1467491134

Taxonomy: 3416L0300X - Ambulance

CLIA Record

Field Name	Field Value
CLIA Number	27D2102028
LAB Type	Ambulance
Facility Name	MISSOULA EMERGENCY SERVICE
Street	2680 PALMER ST
City	MISSOULA
State	MT
ZIP	59808
Phone	406 549-2325
CertificateType	4
CertificateEffectiveDate	9/15/2023
CertificateExpirationDate	9/14/2025
FacilityType	Waiver

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