36D2163712 CLIA NUMBER - SOUTH EAST AMBULANCE DISTRICT

Laboratory Demographics

CLIA Number: 36D2163712

Facility Name: SOUTH EAST AMBULANCE DISTRICT

Facility Address:
1968 MERMILL ROAD
BRADNER, OH
ZIP 43406
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Facility Phone Number: 419 575-1544

Facility Type: Ambulance

Certificate Type: Waiver

NPI Number: 1629535133

Taxonomy: 3416L0300X - Ambulance

CLIA Record

Field Name	Field Value
CLIA Number	36D2163712
LAB Type	Ambulance
Facility Name	SOUTH EAST AMBULANCE DISTRICT
Street	1968 MERMILL ROAD
City	BRADNER
State	OH
ZIP	43406
Phone	419 575-1544
CertificateType	4
CertificateEffectiveDate	3/20/2023
CertificateExpirationDate	3/19/2025
FacilityType	Waiver

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