39D2144419 CLIA NUMBER - PINE GROVE COMMUNITY AMBULANCE ASSOCIATION

Laboratory Demographics

  • CLIA Code: 39D2144419
  • Facility Name: PINE GROVE COMMUNITY AMBULANCE ASSOCIATION
  • Facility Address: 46 SPRUCE STREET
    PINE GROVE, PA
    ZIP 17963
  • Facility Phone: 570 617-4002
  • Facility Type: Ambulance
  • Facility Type: Waiver
  • Lab Director: DAVID T. LUKASEWICZ
  • NPI Number: 1710913264
  • Taxonomy: 251300000X - Local Education Agency (LEA)

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CLIA Record

Field Name Field Value
CLIA Number 39D2144419
LAB Type Ambulance
Facility Name PINE GROVE COMMUNITY AMBULANCE ASSOCIATION
Street 46 SPRUCE STREET
City PINE GROVE
State PA
ZIP 17963
Phone 570 617-4002
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/16/2024
Certificate Expiration Date 2/15/2026
Facility Type Ambulance
Lab Director DAVID T. LUKASEWICZ

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