27D2102714 CLIA NUMBER - PARK CITY AMBULANCE SERVICE

Laboratory Demographics

CLIA Number: 27D2102714

Facility Name: PARK CITY AMBULANCE SERVICE

Facility Address:
110 2ND STREET SW
PARK CITY, MT
ZIP 59063
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Facility Phone Number: 406 633-2015

Facility Type: Ambulance

Certificate Type: Waiver

NPI Number: 1730147430

Taxonomy: 3416L0300X - Ambulance

CLIA Record

Field Name	Field Value
CLIA Number	27D2102714
LAB Type	Ambulance
Facility Name	PARK CITY AMBULANCE SERVICE
Street	110 2ND STREET SW
City	PARK CITY
State	MT
ZIP	59063
Phone	406 633-2015
CertificateType	4
CertificateEffectiveDate	9/28/2023
CertificateExpirationDate	9/27/2025
FacilityType	Waiver

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