45D2003900 CLIA NUMBER - FAYETTE COUNTY EMS - STATION 1

Laboratory Demographics

  • CLIA Code: 45D2003900
  • Facility Name: FAYETTE COUNTY EMS - STATION 1
  • Facility Address: 1721 N. VON MINDEN RD
    LA GRANGE, TX
    ZIP 78945
  • Facility Phone: 979 968-8991
  • Facility Type: Ambulance
  • Facility Type: Waiver
  • Lab Director: JOSHUA L. VANDEVER
  • NPI Number: 1215958863
  • Taxonomy: 3416L0300X - Ambulance

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CLIA Record

Field Name Field Value
CLIA Number 45D2003900
LAB Type Ambulance
Facility Name FAYETTE COUNTY EMS - STATION 1
Street 1721 N. VON MINDEN RD
City LA GRANGE
State TX
ZIP 78945
Phone 979 968-8991
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/22/2024
Certificate Expiration Date 2/21/2026
Facility Type Ambulance
Lab Director JOSHUA L. VANDEVER

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