44D0980740 CLIA NUMBER - LAKE COUNTY EMS

Laboratory Demographics

  • CLIA Code: 44D0980740
  • Facility Name: LAKE COUNTY EMS
  • Facility Address: 333 KENTUCKY STREET
    TIPTONVILLE, TN
    ZIP 38079
  • Facility Phone: (731) 253-9911
  • Facility Type: Ambulance
  • Facility Type: Waiver
  • Lab Director: JACK MAULDIN
  • NPI Number: 1154336758
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 44D0980740
LAB Type Ambulance
Facility Name LAKE COUNTY EMS
Street 333 KENTUCKY STREET
City TIPTONVILLE
State TN
ZIP 38079
Phone 7312539911
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/1/2024
Certificate Expiration Date 11/30/2026
Facility Type Ambulance
Lab Director JACK MAULDIN

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This page was last updated on: 5/18/2026