36D0862504 CLIA NUMBER - JACKSON-FOREST AMBULANCE DISTRICT

Laboratory Demographics

  • CLIA Code: 36D0862504
  • Facility Name: JACKSON-FOREST AMBULANCE DISTRICT
  • Facility Address: 211 WEST LIMA STREET
    FOREST, OH
    ZIP 45843
  • Facility Phone: 419 273-2520
  • Facility Type: Other
  • Facility Type: Waiver
  • Lab Director: MICHAEL R. HUMPHREY MD
  • NPI Number: 1467516948
  • Taxonomy: 341600000X - Ambulance

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CLIA Record

Field Name Field Value
CLIA Number 36D0862504
LAB Type Other
Facility Name JACKSON-FOREST AMBULANCE DISTRICT
Street 211 WEST LIMA STREET
City FOREST
State OH
ZIP 45843
Phone 419 273-2520
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Other
Lab Director MICHAEL R. HUMPHREY MD

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