37D2231115 CLIA NUMBER - AIR EVAC LIFETEAM 165 AIR EVAC EMS, INC

Laboratory Demographics

  • CLIA Code: 37D2231115
  • Facility Name: AIR EVAC LIFETEAM 165 AIR EVAC EMS, INC
  • Facility Address: 872 E 11TH STREET
    GROVE, OK
    ZIP 74344
  • Facility Phone: 918 786-1024
  • Facility Type: Mobile Laboratory
  • Facility Type: Waiver
  • Lab Director: KENNEY DALTON
  • NPI Number: 1760061618
  • Taxonomy: 3416A0800X - Ambulance

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CLIA Record

Field Name Field Value
CLIA Number 37D2231115
LAB Type Mobile Laboratory
Facility Name AIR EVAC LIFETEAM 165 AIR EVAC EMS, INC
Street 872 E 11TH STREET
City GROVE
State OK
ZIP 74344
Phone 918 786-1024
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/30/2025
Certificate Expiration Date 7/29/2027
Facility Type Mobile Laboratory
Lab Director KENNEY DALTON

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