39D1067952 CLIA NUMBER - NANTICOKE FIRE DEPT COMMUNITY AMBULANCE MEDIC 25

Laboratory Demographics

  • CLIA Code: 39D1067952
  • Facility Name: NANTICOKE FIRE DEPT COMMUNITY AMBULANCE MEDIC 25
  • Facility Address: 901 SOUTH HANOVER ST
    NANTICOKE, PA
    ZIP 18634
  • Facility Phone: 570 735-5201
  • Facility Type: Ambulance
  • Facility Type: Waiver
  • Lab Director: DANIEL R. SHAW
  • NPI Number: 1831550599
  • Taxonomy: 101YP2500X - Counselor

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CLIA Record

Field Name Field Value
CLIA Number 39D1067952
LAB Type Ambulance
Facility Name NANTICOKE FIRE DEPT COMMUNITY AMBULANCE MEDIC 25
Street 901 SOUTH HANOVER ST
City NANTICOKE
State PA
ZIP 18634
Phone 570 735-5201
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/30/2025
Certificate Expiration Date 4/29/2027
Facility Type Ambulance
Lab Director DANIEL R. SHAW

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